Unrecognized Patent Foramen Ovale in Patient With Sinus Venosus-Type Atrial Septal Defect With Partial Anomalous Pulmonary Venous Return

Abstract

ASA = atrial septal aneurysm; ASD = atrial septal defect; CFD = color flow Doppler; CPB = cardiopulmonary bypass; CT = computed tomography; HIPAA = Health Insurance Portability and Accountability Act; LV = left ventricular; PAPVR = partial anomalous pulmonary venous return; PFO = patent foramen ovale; RUPV = right upper pulmonary vein; SVASD = sinus venosus-type atrial septal defect; SVC = superior vena cava; TEE = transesophageal echocardiogram; TTE = transthoracic examination Sinus venosus-type atrial septal defect (ASD) represents approximately 4% to 11% of all ASDs and may be associated with other cardiac anomalies, such as anomalous pulmonary venous connection and patent foramen ovale (PFO). 1 The foramen ovale is an interatrial communication that functionally closes after birth, when left atrial pressure exceeds right atrial pressure. A flap defect results from failure of fusion of primum and secundum atrial septa, usually providing an intermittent communication. It is usually a benign finding and affects between 20% and 34% of the adult population. 2 We describe a patient scheduled for repair of a large superior-type sinus venosis-type ASD (SVASD). Intraoperative transesophageal echocardiogram (TEE) before repair did not reveal the presence of a PFO. However, soon after successful patch repair of the ASD, a large PFO was noticeable on TEE examination, necessitating reexploration and repair of the PFO. The clinical implications of an unrecognized PFO are consequential, as it can lead to recurrent embolization. Written Health Insurance Portability and Accountability Act (HIPAA) authorization was obtained from the patient for publication.