Balloon catheter closure of patent foramen ovale complicating right ventricular infarction: Improvement of hypoxia and intracardiac venous shunting

Uppstrom, Erica; Kern, Morton J.; Mezei, Leslie; Mrosek, Denise; Labovitz, Arthur J.

doi:10.1016/0002-8703(88)90165-2

Cited by 20 publications

(5 citation statements)

References 14 publications

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“…87 Although nonsurgical transcatheter closure may be the future treatment of choice for atrial septal defect, no long-term results are currently available. 42,46,[88][89][90] Ultimately, the most costeffective and efficacious diagnostic and treatment strategy is yet to be determined, and individual approaches will vary based on available hospital resources and expertise at any given institution. We propose a potential management algorithm in Figure 5.…”

Section: Treatment Of Pdementioning

confidence: 99%

Impending Paradoxical Embolism

Meacham¹,

Headley²,

Bronze³

et al. 1998

Arch Intern Med

101

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The advent of echocardiography has led to the more frequent discovery of impending paradoxical embolism. Paradoxical embolism should be considered whenever there is an arterial embolism from an unidentified source in the presence of a concomitant venous thromboembolic phenomenon. Patients with paradoxical embolism present with neurological abnormalities or features suggesting arterial embolism. Annually, paradoxical embolism may account for up to 47,000 strokes in the United States, and a patent foramen ovale has been reported in up to 35% of the normal population. Events that give rise to pulmonary hypertension may result in a right-to-left shunt through a patent foramen ovale allowing a venous thromboembolism access to the arterial circulation. Herein we report a case of impending paradoxical embolism and review the pertinent literature.

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Section: Treatment Of Pdementioning

confidence: 99%

Impending Paradoxical Embolism

Meacham¹,

Headley²,

Bronze³

et al. 1998

Arch Intern Med

101

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“…The use of nitrates to reduce RA pressure by venodilation has been advocated. 6 It has also been suggested that nitrates can be used as a bedside diagnostic test in right-to-left shunt, showing an immediate increase in systemic oxygen saturation. 5 However, despite encouraging results, the clinical use of nitrates has limited acceptance.…”

Section: Discussionmentioning

confidence: 99%

“…5 However, despite encouraging results, the clinical use of nitrates has limited acceptance. 6 Arterial vasodilators can exaggerate the shunt by lowering LA pressure and should not be used. 7 Beta blockers have been used with favorable results.…”

Section: Discussionmentioning

confidence: 99%

“…Closure of the patent foramen ovale by surgical or percutaneous means has been accomplished with limited clinical success. 5,6,9,[10][11][12][13][14] It has been suggested that closure of a patent foramen ovale can be detrimental to clinical status by reducing LV filling and increasing filling of the noncompliant RV. Five out of 8 patients who had closure of a patent foramen ovale died.…”

Section: Discussionmentioning

confidence: 99%

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Intracardiac Right-to-Left Shunt Complicating Right Ventricular Failure

Sharif

Pezzella

Farah

et al. 1999

Asian Cardiovasc Thorac Ann

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Three cases of intracardiac right-to-left shunt at the atrial level complicating right ventricular failure (RV) are described. Severe hypoxemia resulted in 2 patients and stroke in the third. This was a consequence of right ventricular infarction causing right-sided heart failure resulting in high right-sided pressures. Echocardiography demonstrated the shunts. A review of the literature on this uncommon problem suggested management strategies based on the limited experience with this condition.

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“…Pulmonary artery balloon counterpulsation was reported to be effective in a patient with RV infarction unresponsive to other measures.6s Also, coronary angioplasty during the acute phase of the infarction has been reported to result in rapid improvement in RV function.66 Balloon closure of a patent foramen ovale, although ultimately unsuccessful, was shown to improve systemic arterial saturation in a patient with significant right to left shunting. 67 If an arrhythmia occurs which requires temporary pacing, an atrial or AV sequential pacemaker is preferable.68.69 Ventricular pacing in this setting has been reported to result in hemodynamic deterioration, probably from the loss of an effective atrial contraction as well as altered sequence of ventricular contraction.…”

Section: Managementmentioning

confidence: 99%

Right Ventricular Infarction

1990

Clinical Cardiology

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Summary: Right ventricular infarction commonly occurs in association with acute inferior left ventricular infarction, but is uncommon when infarction involves other areas of the left ventricle. Evidence of right ventricular infarction often can be detected by physical examination, electrocardiography, echocardiography , or radionuclide ventriculography . However, hemodynamically signifcant infarction (i.e., hypotension or shock) is much less frequent, occurring in approximately 10% of patients with other evidence of right ventricular infarction. Right ventricular infarction increases ventricular stiffness, thereby impeding diastolic filling. This results in hemodynamic changes similar to those found in constrictive pericarditis: elevated systemic venous pressure, a Y descent greater than the X descent, and an inspiratory increase in venous pressure. The increase in venous pressure generally equals or even exceeds left atrial pressure. When hypotension or shock occurs, expansion of vascular volume is generally employed as initial therapy. In nonresponders, dobutamine or similar inotropic agents may be helpful. The prognosis during the acute phases is guarded, but, in survivors, prognosis is favorable and generally related to the extent of left ventricular involvement.

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Balloon catheter closure of patent foramen ovale complicating right ventricular infarction: Improvement of hypoxia and intracardiac venous shunting

Cited by 20 publications

References 14 publications

Impending Paradoxical Embolism

Impending Paradoxical Embolism

Intracardiac Right-to-Left Shunt Complicating Right Ventricular Failure

Right Ventricular Infarction

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