• Giuseppe M Raffa, Carlo Pellegrini, Salvatore Lentini, Sossio Perrotta, Fabrizio Tancredi, Roberto Gaeta, and Mario Viganò.
• Department of Cardiac Surgery, University of Pavia, Pavia, Italy. raffagiuseppe@yahoo.it
• J Card Surg. 2008 Jan 1;23(1):75-8.

BackgroundThe 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.MethodsA 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.ResultsPostoperative course was uneventful. Complete obliteration of the fistula was achieved.ConclusionMinimally 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.

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