PIG Meeting: 8th July 2021

66yo lady for laparoscopic hysterectomy and BSO for complex ovarian cyst. Tumour markers negative, thought non-cancerous.

Background:

• Recurrent TIAs/syncopal events, ongoing for many years. Well known to neurologist. Normal cerebral imaging. DDX; epilepsy vs anxiety related.
• Patient declined loop recorder to exclude bradyarrhythmias
• Possible PFO – Echo showed aneurysmal and mobile intra-atrial septum. R-to-L shunt. Patient declined F/U for assessment of PFO and closure if indicated. Episodes could represent recurrent micro-embolic episodes via the PFO.
• Cerebral aneurysm clipping 2013
• Smoker, 45PYH
• Thyroidectomy
• Severe anxiety and depression. ++ psychosocial issues

Issues:

• Syncopal episodes of unknown origin, likely not organic cause but need to exclude PFO and bradyarrhythmia

Discussion

• PFO and laparoscopic surgery – risk of venous air embolism. It is not prudent to proceed while this issue has not been resolved.
• Given the gynae procedure is not urgent but the patient is keen to proceed, this provides a timescale to follow up these medical issues.

Plan:

• Clinic doctor to liaise with surgical team/GP to ensure issues are investigated/managed appropriately prior to procedure.