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clinical investigations: Cardiovascular and Cardiac Surgery: Journal ArticleThe Prevalence and Significance of a Patent Foramen Ovale in Pulmonary Hypertension
Section snippets
Patients
Fifty-eight consecutive patients with pulmonary hypertension (44 female, 14 male), with a mean age of 42 ± 11 (range, 15 to 69) years, were studied. All patients were evaluated for the etiology of their pulmonary hypertension based on the protocol used in the National Institutes of Health Registry on Primary Pulmonary Hypertension.2 Pulmonary hypertension was diagnosed as primary in 40 patients (69 percent) and secondary in 18 (31 percent).
Patent Foramen Ovale Detection
Transesophageal echocardiography was performed using a
RESULTS
A PFO was present in 26 percent (15 of 58) of all patients studied, 25 percent (10 of 40) of the patients with PPH, and in 28 percent (5 of 18) of the patients with secondary pulmonary hypertension.
Hemodynamics, resting arterial oxygen saturation levels with patients breathing room air, and exercise times for the groups with and without a PFO are given in Table 1. The patients studied had severe pulmonary hypertension with a mean pulmonary artery pressure of 55 ± 15 mm Hg, pulmonary vascular
DISCUSSION
A PFO has been reported in 25 to 35 percent of normal patients at autopsy.5 Several retrospective studies have reported a prevalence from 12 to 31 percent in patients with PPH.1, 6, 7 The methods of detection, however, include right-sided heart catheterization and transthoracic echocardiography which, due to technical limitations, tend to underreport the actual prevalence.3 Recently, contrast transesophageal echocardiography was reported to be possibly the most sensitive and specific test for
APPENDIX
A proportional hazards model is used to predict survival of primary pulmonary hypertension (PPH) patients. The probability of a given PPH patient surviving past t years, given hemodynamic variables collected at baseline, is where t ranges from one to five years, and the hemodynamic variables are x = mean pulmonary artery pressure, y = mean right atrial pressure, and z = cardiac index.
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Cited by (51)
Agitated Saline Contrast Echocardiography in the Identification of Intra- and Extracardiac Shunts: Connecting the Dots
2021, Journal of the American Society of EchocardiographyCitation Excerpt :Conversely, multiple studies have looked at the effects of pulmonary hypertension on PFO detection and whether it would increase rates of detection. Interestingly, however, identification rates of a PFO are unchanged from that of the general population.55,56 Increased RV size and decreased RV function have been associated with increased PFO detection rates, whereas echocardiographically measured RV systolic pressure has not.56
Hypoxemia and PFO
2019, Patent Foramen Ovale Closure for Stroke, Myocardial Infarction, Peripheral Embolism, Migraine, and HypoxemiaPatent Foramen Ovale Closure for Hypoxemia
2017, Interventional Cardiology ClinicsCitation Excerpt :With time, the septum primum and secundum fuse leaving behind the fossa ovalis. For approximately 20% of the population this fusion remains incomplete, resulting in a PFO.4–6 In most people who have a PFO, it is an incidental finding and not associated with symptoms or hypoxemia.
Patent foramen ovale in idiopathic pulmonary arterial hypertension: Long-term risk and morbidity
2016, Respiratory MedicineCitation Excerpt :Studies done in patients with PH secondary to sleep disorder breathing and chronic obstructive pulmonary disease) found an association between PFO presence and increased MPAP [25,26]. However, Nootens et al. in their study of 58 patients with PH of varied etiologies, found PFO had no correlation with any hemodynamic parameter as measured by RHC during rest [22]. As seen in patients with atrial septostomy, one may expect decreased right-sided pressures due to shunting at the expense of worsened hypoxemia, as well as improved cardiac output [14,16].
Pulmonary hypertension and congenital heart disease: An insight from the REHAP national registry
2015, International Journal of CardiologyRight-to-left atrial shunting associated with aortic root aneurysm: A case report of a rare cause of platypnea-orthodeoxia syndrome
2013, Heart Lung and CirculationCitation Excerpt :Reversal of the left-to-right atrial pressure differential can occur in association with the substantial haemodynamic changes caused by physiologic manoeuvres that increase right atrial pressure, such as posture change, inspiration, cough, or valsalva manoeuvres [13]. In addition, this pressure differential reversal can occur in association with pathologic conditions characterised by high pulmonary vascular resistance [14], such as acute pulmonary embolism [15], hypoxaemia due to obstructive sleep apnoea [16], severe chronic obstructive pulmonary disease [17], or right ventricular infarction [18]. The right-to-left atrial shunt in the platypnea–orthodeoxia syndrome occurs despite normal right atrial pressure and vascular pulmonary resistance.