title: Minimally invasive video-assisted surgery for iatrogenic aortic root-to-right atrium fistula after incomplete percutaneous occlusion of patent foramen ovale: case report and review of the literature.
abstract: BACKGROUND
  The foramen ovale remains patent in about 25% of the population. Paradoxical embolism through a patent foramen ovale (PFO) may produce ischemic events. The closure of a PFO may prevent recurrence of cerebrovascular events. Percutaneous closure of a PFO is now-a-days a standard procedure and it appears to carry a low rate of complications. A surgical approach, in some cases, may be needed.
  
  
  METHODS
  A patient underwent percutaneous closure of PFO. There was a residual shunt after the procedure and a fistula between the aortic root-to-right atrium was subsequently discovered. Surgery was carried out using a "Port-Access technique" through a right anterior minithoracotomy.
  
  
  RESULTS
  Postoperative course was uneventful. Complete obliteration of the fistula was achieved.
  
  
  CONCLUSIONS
  Minimally invasive surgery may be effective to treat PFO or even complications after previous percutaneous attempts of closure. An aesthetically acceptable conclusion, especially in young female patients, and a very low rate of morbidity may be accomplished.
authors.affiliation: Department of Cardiac Surgery, University of Pavia, Pavia, Italy. raffagiuseppe@yahoo.it
authors.forename: Giuseppe M
authors.initials: GM
authors.lastname: Raffa
authors.forename: Carlo
authors.initials: C
authors.lastname: Pellegrini
authors.forename: Salvatore
authors.initials: S
authors.lastname: Lentini
authors.forename: Sossio
authors.initials: S
authors.lastname: Perrotta
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Tancredi
authors.forename: Roberto
authors.initials: R
authors.lastname: Gaeta
authors.forename: Mario
authors.initials: M
authors.lastname: Viganò
mesh_terms: D000328:Adult; D001011:Aorta / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D054092:Foramen Ovale, Patent / Q000601:surgery*; D006325:Heart Atria / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease; D013997:Time Factors; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D020535:Video-Assisted Surgery