Perioperative Anesthetic Management of a Patient with Patent Foramen Ovale Undergoing Laparoscopic Gynecologic Oncology Surgery: A Case Report
Patent Foramen Ovale in Gynecologic Oncology Laparoscopy
DOI:
https://doi.org/10.71350/ajaic.28Keywords:
Laparoscopy, Hysterectomy, Patent foramen ovale, Paradoxical embolism, Regional oxygen saturation, General anesthesiaAbstract
Background: Patent foramen ovale (PFO), present in approximately 20–25% of adults, may predispose patients to paradoxical embolism in clinical settings associated with increased right atrial pressure. Laparoscopic gynecologic oncology procedures require carbon dioxide pneumoperitoneum and Trendelenburg positioning, both of which may augment right-to-left intracardiac shunting and increase the risk of venous air embolism and perioperative cerebral ischemia. Optimal perioperative management strategies in this population remain a matter of clinical concern, particularly when preoperative PFO closure is not feasible.
Case Presentation: A 64-year-old woman with incidentally diagnosed PFO underwent total laparoscopic hysterectomy and surgical staging for endometrial cancer. An individualized anesthetic plan emphasizing embolism prevention was implemented. Pneumoperitoneum pressure was limited to 10–12 mmHg, lung-protective ventilation was applied, and strict hemodynamic targets were maintained. Continuous neuromonitoring with bispectral index and near-infrared spectroscopy–based cerebral oximetry was used to detect early perfusion compromise. Intraoperative cerebral oxygen saturation remained within predefined safety margins, and no embolic or neurologic complications occurred.
Conclusions: In time-sensitive oncologic surgery, meticulous perioperative optimization and advanced monitoring may provide a safe alternative to delaying surgery for PFO closure. A multidisciplinary, risk-adapted approach is essential to minimize paradoxical embolic events in this high-risk population.
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