Patent Foramen Ovale, Friend or Foe in Heart Failure Patients?

Antoine, Steve; Maldonado, Andres Pineda; Rivas, Jose; Smotherman, Carmen; Gautam, Shiva; Miller, Alan B.

doi:10.1016/s0735-1097(19)31592-x

Cited by 1 publication

(2 citation statements)

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“…In the presented case, considering the PFO detection with a right-to-left shunt and the history of previous CVA, the percutaneous closure of the defect seemed to be indicated [6], since the worsening of PH induced by exercise increases the possibility of paradoxical embolism, especially in the presence of an ICD lead. However, in this setting of patients, it could be possible that PFO closure may worsen haemodynamic [16,17]. In fact, in the setting of HF, patients are more prone to develop PH during exercise, and the PFO may represent an outlet valve for the left atrial pressure increase during effort [17,18], while right heart chambers are more compliant to increased afterload.…”

Section: Discussionmentioning

confidence: 99%

“…However, in this setting of patients, it could be possible that PFO closure may worsen haemodynamic [16,17]. In fact, in the setting of HF, patients are more prone to develop PH during exercise, and the PFO may represent an outlet valve for the left atrial pressure increase during effort [17,18], while right heart chambers are more compliant to increased afterload. The presence of a PFO can unload the left atrium, and there is evidence that patients with PFO show a lower risk of HF than those without PFO [16].…”

Section: Discussionmentioning

confidence: 99%

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A sudden right-to-left shunt: the importance of evaluating patent foramen ovale during exercise

Crispino

Segreti²,

Porta³

et al. 2023

Monaldi Arch Chest Dis

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A 55-year-old male affected by heart failure with reduced ejection fraction and a history of a transient cerebrovascular accident was accepted to the Cardiology Department for worsening dyspnoea. A cardiopulmonary exercise testing was performed after therapy optimization to further evaluate exercise intolerance. A rapid increase in VE/VCO2 slope, PETO2, and RER, with a concomitant decrease in PETCO2 and SpO2, were observed during the test. These findings indicate exercise-induced pulmonary hypertension leading to a right-to-left shunt. Subsequent echocardiography with a bubble test unveiled the presence of an unknown patent foramen ovale. It is, therefore, necessary to exclude a right-to-left shunt by cardiopulmonary exercise testing, particularly in patients predisposed to develop pulmonary hypertension during exercise. Indeed, this eventuality might potentially provoke severe cardiovascular embolisms. However, the patent foramen ovale closure in patients with heart failure with reduced ejection fraction is still debated because of its potential hemodynamic worsening.

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