Percutaneous Closure of Patent Foramen Ovale in the Setting of Pulmonary Embolism (Right-Left Shunt Causing Severe Hypoxia)

Abstract

A patent foramen ovale (PFO) is well known to cause paradoxical embolism and stroke, but a less appreciated and life-threatening complication can occur when combined with severe pulmonary embolism (PE). Acutely elevated right-sided pressures from right ventricular strain due to PE can lead to right-to-left (R-L) shunting through the PFO and exacerbate hypoxia. We report a case of a 50-year-old female patient with massive PE with further desaturation from R-L shunting from a PFO that benefitted from percutaneous closure of the interartrial communication. Our patient recovered without any complications and had excellent long-term follow-up.

Relationship between right‐to‐left shunt, hypoxia, and epilepsy

“…The closure operation is currently considered as the first‐line treatment for cryptogenic stroke, severe OSA, and improvement of migraine frequency and severity 5,6 . RLS closure is associated with an improvement in oxygen saturation (SaO 2 ) and may convey collateral benefits to the neurologic system, especially in those with lung disease complications 7 . Epilepsy is characterized by unprovoked seizures with manifestations of abnormally synchronized electrical activity due to neuronal hyperexcitability 8 .…”