Effectiveness of Percutaneous Closure of Patent Foramen Ovale for Hypoxemia

Fenster, Brett E.; Nguyen, Bryant; Buckner, J. Kern; Freeman, Andrew M.; Carroll, John D.

doi:10.1016/j.amjcard.2013.06.022

Cited by 36 publications

(29 citation statements)

References 9 publications

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“…Surgical closure of the PFO may be undertaken for various reasons, such as history of stroke or transient ischaemic attack, yet PFO closure for this purpose remains controversial. However, because PFO contributes to arterial hypoxaemia in subjects with CHF and pulmonary hypertension, these specific subjects may also benefit from PFO closure as an intervention to improve oxygenation, particularly in those subjects with more severe levels of hypoxaemia (Ilkhanoff et al 2005;Fenster et al 2013).…”

Section: Discussionmentioning

confidence: 99%

“…Blood flow though a patent foramen ovale (PFO;Q PFO ) is present in at least 30% of the general population (Woods et al 2010;Elliott et al 2013;Marriott et al 2013) and is known to reduce pulmonary gas exchange efficiency in healthy humans Elliott et al 2015) and patient populations (Ilkhanoff et al 2005;Fenster et al 2013). With increased right atrial pressures in subjects with CHF and pulmonary hypertension,Q PFO might be even greater than that in conditions of normal right atrial pressure, and thus,Q PFO could have an even greater potential to worsen pulmonary gas exchange efficiency in these subjects.…”

Section: Introductionmentioning

confidence: 99%

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Resting arterial hypoxaemia in subjects with chronic heart failure, pulmonary hypertension and patent foramen ovale

Lovering

Lozo

Barak

et al. 2016

Experimental Physiology

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New Findings r What is the central question of this study?Does a patent foramen ovale contribute to resting arterial hypoxaemia, defined as arterial oxygen saturation <95%, in subjects with chronic heart failure with or without pulmonary arterial hypertension? r What is the main finding and its importance?The presence of a patent foramen ovale contributed to resting arterial hypoxaemia only in subjects with chronic heart failure with pulmonary arterial hypertension. These data suggest that the presence of a patent foramen ovale should be considered in chronic heart failure patients with arterial hypoxaemia and pulmonary hypertension.The roles of intrapulmonary and intracardiac shunt in contributing to arterial hypoxaemia at rest in subjects with chronic heart failure (CHF) have not been well investigated. We hypothesized that blood flow through intrapulmonary arteriovenous anastomoses (Q IPAVA ) and/or patent foramen ovale (Q PFO ) could potentially contribute to arterial hypoxaemia and, with pulmonary hypertension (PH) secondary to CHF, this contribution may be exacerbated. Fifty-six subjects with CHF (New York Heart Association Classes I-III), with (+) or without (−) PH [defined as peak tricuspid regurgitation velocity ࣙ2.9 m s −1 (CHF PH+, n = 32) and peak tricuspid regurgitation velocity ࣘ2.8 m s −1 (CHF PH−, n = 24)], underwent arterial blood gas analysis and transthoracic saline contrast echocardiography concomitant with transcranial Doppler to detectQ IPAVA andQ PFO . Seventeen of 56 subjects with CHF (30%) hadQ PFO , but only four of 56 subjects with CHF hadQ IPAVA (7%), both similar to age-and sex-matched control subjects. Mean arterial oxygen saturation (S aO 2 ) was lower in subjects withQ PFO . Only CHF PH+ subjects withQ PFO had arterial hypoxaemia (mean S aO 2 <95%). Bubble scores assessed using transthoracic saline contrast echocardiography were correlated with microembolic signals detected with transcranial Doppler in subjects withQ PFO . SignificantQ IPAVA was not present in either CHF PH+ or PH− subjects, suggesting thatQ IPAVA is not dependent on increased A. T. Lovering and others pulmonary pressure and does not contribute significantly to arterial hypoxaemia in older subjects with CHF. Given that S aO 2 was lower in all subjects with CHF who hadQ PFO compared with those withoutQ PFO , a patent foramen ovale should be considered when determining potential causes of arterial hypoxaemia, becauseQ PFO was present in 30% of these subjects.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Resting arterial hypoxaemia in subjects with chronic heart failure, pulmonary hypertension and patent foramen ovale

Lovering

Lozo

Barak

et al. 2016

Experimental Physiology

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“…The rationale for percutaneous device closure is supported by the work of Fenster et al ,8 Devendra et al 9 and El Tahlawi et al ,10 who reported significant symptomatic and functional status improvement in their respective cohorts with this therapy. The common denominator in their series was the absence of significant pulmonary hypertension in recipients of percutaneous closure devices.…”

Section: Treatmentmentioning

confidence: 97%

A 58-year-old woman with hypoxia, hypoxaemia, a hole in the heart and a … herring! Intracardiac or extracardiac shunt? That is the question!

et al. 2015

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SUMMARYWe describe a case of a previously healthy 58-year-old woman who presented with gradual onset shortness of breath on exertion, erythrocytosis, hypoxia and hypoxaemia. Initial investigations revealed a normal chest radiography and pulmonary function test, however, there was an isolated reduction in diffusion capacity. She was subsequently found to have a patent foramen ovale (PFO) with intermittent shunting. A contrast echocardiography study hinted towards an extracardiac shunt. No shunt was detected in spite of using advanced imaging techniques. A lung biopsy was ultimately performed and histopathology revealed diffuse microvascular pulmonary arteriovenous malformations. This is one of few cases reported of this rare vascular abnormality and highlights its strong genetic association with hereditary haemorrhagic telangiectasia. The diagnostic challenges and management of this unique condition are reviewed in detail. BACKGROUND

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“…Notably, in all of the cases detailed in Table 1, hypoxia improved immediately following PFO closure. Similarly, the case studies of patients with platypnea-orthodeoxia syndrome undergoing PFO closure report a signifi cant postprocedural increase in blood oxygen saturation and excellent long-term outcomes (23,25). effi cacy of the Amplatzer PFO Occluder device over the previously used STARFlex Septal Closure System (2, 4).…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Percutaneous Closure of Patent Foramen Ovale for Hypoxia

Munkres

Ball

Chamogeorgakis

et al. 2015

Baylor University Medical Center Proceedings

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We report a patient with hypoxia secondary to a right-to-left shunt through a patent foramen ovale, following aortic root, valve, and arch replacement due to an aortic dissection in the setting of the Marfan syndrome. Following the operation, he failed extubation twice due to hypoxia. An extensive workup revealed a right-to-left shunt previously not seen. The patent foramen ovale was closed using a percutaneous closure device. Following closure, our patient was extubated without difficulty and has done well postoperatively.A pproximately 25% of the general population is estimated to have a patent foramen ovale (PFO). Th ese small atrial septal defects, present from birth, are usually asymptomatic and found incidentally by echocardiogram or at autopsy (1). We describe the benefi t of closure of a PFO for postoperative hypoxia. CASE DESCRIPTIONA 23-year-old Hispanic man with the Marfan syndrome presented with acute chest pain that radiated to his back. Th e diagnosis of a dilated aortic root and a type B aortic dissection was made quickly by computed tomography scan with contrast. He underwent surgical repair using a two-staged "elephant trunk" procedure. Th e initial stage of the procedure consists of an aortic valve, root, and arch replacement, including leaving an elephant trunk portion of the graft that hangs down into the descending aorta. Finally the descending thoracic aorta is wrapped at that level of the diaphragm. Th e second stage of the procedure uses a stent graft, via an endovascular approach, to connect the elephant trunk with the wrapped portion of the aorta. Following the fi rst stage, his postoperative course was complicated by recurrent hypoxia. He underwent two attempted extubations on postoperative days 1 and 7, but the hypoxia persisted. A PFO with a signifi cant right-to-left shunt was found on transesophageal echocardiogram with bubble study (Figure 1).On postoperative day 9, a percutaneous closure procedure was performed via the right femoral vein. A #25 Amplatzer Cribriform Septal Occluder (AGA Medical Corp., Plymouth, MN) was deployed in the PFO, and placement was confi rmed with intracardiac echocardiography and fl uoroscopy (Figure 2). A negative echocardiographic bubble study at the conclusion of the procedure confi rmed resolution of the right-to-left shunt. On day 10, extubation was successful and normal oxygen saturation was maintained. Th e patient was discharged from the hospital on postoperative day 22. Five weeks later, he underwent stage 2 of the "elephant trunk" procedure without postoperative respiratory complications. He continues to do well 5 months following the second stage of the procedure. DISCUSSIONDespite the severity of potential consequences of a PFO, hypothesized benefi ts of closing PFOs, specifi cally for migraine headaches and strokes, have not resulted in clinical benefi t over standard medical management. Th ree large randomized controlled trials, RESPECT (2), CLOSURE I (3), and PC Trial (4), failed to show a benefi t of PFO closure over medical management fo...

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Effectiveness of Percutaneous Closure of Patent Foramen Ovale for Hypoxemia

Cited by 36 publications

References 9 publications

Resting arterial hypoxaemia in subjects with chronic heart failure, pulmonary hypertension and patent foramen ovale

Resting arterial hypoxaemia in subjects with chronic heart failure, pulmonary hypertension and patent foramen ovale

A 58-year-old woman with hypoxia, hypoxaemia, a hole in the heart and a … herring! Intracardiac or extracardiac shunt? That is the question!

Usefulness of Percutaneous Closure of Patent Foramen Ovale for Hypoxia

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