Hypoxemia-orthodeoxia related to patent foramen ovale without pulmonary hypertension

Anne Claire Toffart, Hélène Bouvaist, Virginie Feral, Dominique Blin, Christophe Pison
Heart & Lung: the Journal of Critical Care 2008, 37 (5): 385-9

OBJECTIVE: Patent foramen ovale (PFO) is frequent but rarely associated with platypnea-orthodeoxia syndrome and with no pulmonary hypertension.

MATERIALS AND METHODS: We performed a retrospective analysis of 12 consecutive patients with hypoxemia and PFO without increased pulmonary arterial pressure. The study was conducted at a single-center university hospital. We analyzed the patients' clinical records, gas exchange, contrast echocardiography studies, and survival.

RESULTS: Twelve patients, aged 73.1 +/- 9.5 years, were diagnosed with PFO between 1993 and 2005. All patients experienced dyspnea and/or hypoxemia. Six right hemidiaphragmatic elevations were observed on radiography. The shunt was apparent in three patients using transthoracic echocardiography and in all patients using transesophageal echocardiography. The mean follow-up was 27.6 +/- 32.9 months. The PFO was closed in eight patients, six via percutaneous approach and two via surgery.

CONCLUSION: PFO may be patent and responsible for hypoxemia without pulmonary hypertension. This condition is easily recognized with transesophageal echocardiography, leading in most cases to a percutaneous closure resulting in a dramatic correction of hypoxemia.

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