Patent Foramen Ovale and Hypoxemia. Issue 1 (January 2019)

• Record Type: Journal Article
• Authors: Mojadidi, Mohammad K.; Ruiz, Juan C.; Chertoff, Jason; Zaman, Muhammad O.; Elgendy, Islam Y.; Mahmoud, Ahmed N.; Al-Ani, Mohammad; Elgendy, Akram Y.; Patel, Nimesh K.; Shantha, Ghanshyam; Tobis, Jonathan M.; Meier, Bernhard
• Is Part Of: Cardiology in review. Volume 27:Issue 1(2019)
• Publication Date: 2019-01
• Subjects: patent foramen ovale -- hypoxemia -- right-to-left shunt -- chronic obstructive pulmonary disease -- sleep apnea -- platypnea–orthodeoxia; Cardiology -- Periodicals; 616.12
• DOI: 10.1097/CRD.0000000000000205
• Languages: English
• ISSNs: 1061-5377

Abstract

Abstract : Patent foramen ovale (PFO), an embryonic remnant of the fetal circulation, is present in 20–25% of adults. Although recent observational studies and clinical trials have established the link between PFO-mediated right-to-left shunting with cryptogenic stroke and migraine with aura, the role of a PFO in exacerbating hypoxemic medical conditions (ie, sleep apnea, chronic obstructive pulmonary disease, pulmonary hypertension, platypnea–orthodeoxia, pulmonary arteriovenous malformation, high-altitude pulmonary edema, and exercise desaturation) remains less understood. PFO-mediated hypoxemia occurs when deoxygenated venous blood from the right atrium enters and mixes with oxygenated arterial blood in the left atrium. Patients with an intracardiac right-to-left shunt may have profound hypoxemia out of proportion to underlying primary lung disease, even in the presence of normal right-sided pressures. The presence of right-to-left cardiac shunting can exacerbate the degree of hypoxemia in patients with underlying pulmonary disorders. In a subset of these patients, percutaneous PFO closure may result in marked improvement in dyspnea and hypoxemia. This review discusses the association between PFO-mediated right-to-left shunting with medical conditions associated with hypoxemia and explores the role of percutaneous PFO closure in alleviating the hypoxemia.