Cholecystectomy in the presence of a large patent foramen ovale: laparoscopic or open?

The difficulty of choosing between two risks: laparoscopic or open cholecystectomy in the presence of a large patent foramen ovale

“…3) When a coelioscopy is planned in a patient known to have a PFO. Reply We appreciate Dr. Fischler's thoughtful letter in response to our case report [1]. We agree with his important comments regarding: vigilance in electrocardiographic monitoring for cardiac ischemia that might result from sudden profound hypotension or gas occlusion in coronary arteries; the benefits of short-acting anesthesia agents to assure early emergence and neurological assessment; and the importance of prolonged postoperative monitoring.…”

“…[1] present the case of an obese patient who was scheduled for an emergent laparoscopic cholecystectomy and who had a large patent foramen ovale (PFO) with a right-to-left shunt. The authors chose the laparoscopic approach after considering the pros and cons.…”

Patent Foramen Ovale Closed Before Robotic Radical Prostatectomy

“…Indeed, TEE revealed an interatrial septum aneurysm with a PFO. 4 On the other hand, Thoma et al 5 described the case of a patient having a large PFO without any related sign scheduled for a cholecystectomy; finally they retained a laparoscopic approach.…”

“…15 Otherwise, carbon dioxide induces local toxicity with major local acidosis induced by the gas diffusion, and finally a general inflammatory reaction due to liberation of cytokines from the injured arterial endothelium. 16 Despite these well-known complications reported in multiple clinical cases, Thoma et al 5 chose not to close the PFO of a patient scheduled for a laparoscopic cholecystectomy and known to have this defect. Their principal points were the safety of small intravascular quantities of carbon dioxide because of the high solubility of carbon dioxide with rapid absorption of bubbles 17 and the reversal of clinical signs of carbon dioxide embolism.…”

“…Their principal points were the safety of small intravascular quantities of carbon dioxide because of the high solubility of carbon dioxide with rapid absorption of bubbles 17 and the reversal of clinical signs of carbon dioxide embolism. Thoma et al 5 cited the use of carbon dioxide for angiography to reinforce the low risk of their intravascular injection, but they also wrote that cerebral angiography with carbon dioxide contrast is considered unsafe, with bubble-related vaso-occlusion. 18 Finally, Thoma et al 5 concluded that the benefits of laparoscopic surgery, with better postoperative course after laparoscopic procedures compared with open surgery, greatly exceed the immeasurably small risk of paradoxical emboli.…”