title: Cryptogenic stroke following abdominal free flap breast reconstruction surgery.
abstract: BACKGROUND
  Abdominal free flap breast reconstruction is regarded as the gold standard method of post-mastectomy breast reconstruction by many. It is a major surgery which can be associated with varied systemic complications. To date, there have been no reports of cerebrovascular complications in the literature which examine the possible relation between thromboembolism and patent foramen ovale (PFO) in patients undergoing microvascular breast reconstruction.
  
  
  METHODS
  A 54-year old female with a pre-existing PFO developed a stroke following bilateral mastectomies and immediate free flap breast reconstruction on postoperative day 5. This was attributed to an air embolus caused by central venous pressure line removal. After uneventful intra and early postoperative periods, the patient had collapsed suddenly on day 5 and become unresponsive immediately following the removal of a central venous line. Brain magnetic resonance imaging confirmed a cerebrovascular accident. This resolved within 48h following therapeutic heparinisation. A clinical diagnosis of paradoxical embolism was made and she was subsequently referred to the cardiologists for angiographic closure of the PFO.
  
  
  CONCLUSIONS
  The case study herein reported gives an account that PFO can have considerable health implications in the early postoperative period and conceivably intraoperatively in patients undergoing major reconstructive surgeries.
  
  
  CONCLUSIONS
  Surgeons and cardiologists should be aware of this cerebrovascular complication secondary to PFO following major reconstructive surgery such as microvascular breast reconstruction. It also serves to challenge microvascular surgeons to reconsider routine use of central venous pressure lines in free flap patients who might otherwise have good peripheral vessels for postoperative fluid and antibiotic administration.
authors.affiliation: School of Clinical Medicine, University College Cork, Ireland.
authors.forename: Huizhuang
authors.initials: H
authors.lastname: Xie
authors.affiliation: Plastic & Reconstructive Surgery Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, UK; Postgraduate Medical Institute at Anglia Ruskin University, Cambridge & Chelmsford, UK. Electronic address: cmalata@hotmail.com.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Malata
keywords: CVA (cerebrovascular accident); Cardiovascular abnormalities; Cryptogenic stroke; Microvascular breast reconstruction; Patent foramen ovale (PFO); Unusual complication of DIEP flap