Percutaneous closure of patent foramen ovale for treatment of hypoxemia: A case series and physiology review

Robl, Jared; Vutthikraivit, Wasawat; Horwitz, Phillip A.; Panaich, Sidakpal

doi:10.1002/ccd.30317

Cited by 3 publications

(2 citation statements)

References 16 publications

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“…This finding provides real-world evidence to support the relationship between PFOs and migraine. One of the main hypotheses is that PFO-induced RLS caused venous blood to mix with arterial blood, resulting in lower blood oxygen content being delivered to the brain [9,10], and therefore hypoxemia in the brain [13]. Surprisingly, several clinical investigations have shown that hypoxia may cause migraines and auras [14].…”

Section: Nbo May Inhibit Pfo-migrainementioning

confidence: 99%

“…The widely accepted theory is that brain function is influenced by oxygen supply, as glucose and oxygen are the two most important substrates for oxidative metabolism in the brain. Under hypoxic conditions, mitochondria are unable to produce enough ATP to maintain activity of ion pumps in the brain [13]. This results in a series of changes to transmembrane electrochemical gradients, such as rapid and widespread membrane depolarization, which may lead to widespread depression of synaptic transmission and slowing of electric activity [2] (Fig.…”

Section: Nbo May Abrogate Abnormality Of Brain Activitymentioning

confidence: 99%

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Normobaric oxygen may attenuate the headache in patients with patent foramen povale and migraine

et al. 2023

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Background and purposes There has been both great interest in and skepticism about the strategies for headache inhibition in patients with patent foramen ovale and migraines (PFO-migraine). Furthermore, many questions remain about the fundamental pathophysiology of PFO-migraines. Herein, the inhibiting effect of normobaric oxygenation (NBO) on PFO-migraine was analyzed. Methods This real-world self-control study consecutively enrolled patients during the ictal phase of migraines who had patent foramen ovale (PFO) confirmed by Trans esophageal Ultrasound(TEE). After comparing the baseline arterial oxygen partial pressure (PaO2) in their blood gas with that of healthy volunteers, all the patients with PFO-migraine underwent treatment with NBO (8 L/min. for 1 h/q8h) inhalation through a mask. Their clinical symptoms, blood gas, and electroencephalograph (EEG) prior to and post-NBO were compared. Results A total of 39 cases with PFO-migraine (in which 36% of participants only had a small-aperture of PFO) and 20 non-PFO volunteers entered the final analysis. Baseline blood gas analysis results showed that the PaO2 in patients with PFO-migraine were noticeably lower than PaO2 levels in non-PFO volunteers. After all patients with PFO-migraines underwent NBO treatment, 29(74.4%) of them demonstrated dramatic headache attenuation and a remarkable increase in their arterial PaO2 levels after one time treatment of NBO inhalation (p < 0.01). The arterial PaO2 levels in these patients gradually went down during the following 4 h after treatment. 5 patients finished their EEG scans prior to and post-NBO, and 4(80%) were found to have more abnormal slow waves in their baseline EEG maps. In the follow up EEG maps post-NBO treatment for these same 4 patients, the abnormal slow waves disappeared remarkably. Conclusions Patients with PFO–migraine may derive benefit from NBO treatment. PFOs result in arterial hypoxemia due to mixing of venous blood, which ultimately results in brain hypoxia and migraines. This series of events may be the key pathologic link explaining how PFOs lead to migraines. NBO use may attenuate the headaches from migraines by correcting the hypoxemia.

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Section: Nbo May Inhibit Pfo-migrainementioning

confidence: 99%

Section: Nbo May Abrogate Abnormality Of Brain Activitymentioning

confidence: 99%

Normobaric oxygen may attenuate the headache in patients with patent foramen povale and migraine

et al. 2023

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Percutaneous closure of patent foramen ovale for treatment of hypoxemia: A case series and physiology review

Robl

Vutthikraivit

Horwitz

et al. 2022

Cathet Cardio Intervent

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Intracardiac right-to-left shunt (RTLS) mediated hypoxemia is a rare complication of patent foramen ovale (PFO). The process may be potentiated by reversal of the usual trans-atrial pressure gradient, or from alteration of intracardiac geometry such that venous flow is preferentially directed toward the PFO. We describe a series of four patients who presented with hypoxemia, detailing the diagnostic evaluation which led to the ascertainment of intracardiac RTLS across PFO as the culprit pathology. All underwent successful percutaneous closure with rapid resolution of hypoxemia.Particular attention is given to the underlying anatomic and physiologic derangements facilitating the intracardiac RTLS.

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Percutaneous patent foramen ovale closure for hypoxaemia at the age of 73: a case report showing immediate benefit

Witte,

Straver,

Bouma

et al. 2024

European Heart Journal - Case Reports

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Background Approximately 25% of the general population has a patent foramen ovale which remains asymptomatic in the vast majority. Right-to-left shunt mediated hypoxemia is a rare associated condition of patent foramen ovale. Case summary This report describes a case of percutaneous patent foramen ovale closure for hypoxemia in a seventy-three year-old patient showing immediate clinical benefit. She experienced progressive dyspnoea on exertion requiring oxygen therapy. SaO2 was 87% at rest without oxygen therapy, which increased to 98% after percutaneous PFO closure. Conclusion Most PFOs remain clinically insignificant but RLS mediated hypoxemia is a rare phenomenon that can occur even at advanced age. Percutaneous PFO closure is a safe and effective therapy option that provides immediate improvement of hypoxemia.

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Percutaneous closure of patent foramen ovale for treatment of hypoxemia: A case series and physiology review

Cited by 3 publications

References 16 publications

Normobaric oxygen may attenuate the headache in patients with patent foramen povale and migraine

Normobaric oxygen may attenuate the headache in patients with patent foramen povale and migraine

Percutaneous closure of patent foramen ovale for treatment of hypoxemia: A case series and physiology review

Percutaneous patent foramen ovale closure for hypoxaemia at the age of 73: a case report showing immediate benefit

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