Effect of Patent Foramen Ovale in Patients With Pulmonary Hypertension

Sharan, Lauren; Stackhouse, Kathryn; Awerbach, Jordan D.; Bashore, Thomas M.; Krasuski, Richard A.

doi:10.1016/j.amjcard.2018.04.014

Cited by 13 publications

(10 citation statements)

References 20 publications

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“…46,47 Right ventricular dysfunction with an increased incidence of persistent foramen ovale and right-to-left shunting is associated with greater stroke risk. 48,49 Intraoperatively, DHCA adds to the already heightened risk of neurologic injury with CPB because of impaired microcirculation from vasoconstriction and decreased blood viscosity, as well as periods with complete lack of circulation. 50,51 In addition, fluctuation in body temperatures after rewarming resulting in hyperthermia postoperatively has been associated with higher incidence of stroke, poor neurologic outcomes, and increased 30-day mortality.…”

Section: Neurologic Management Postoperative Physiologymentioning

confidence: 99%

Critical Care of Patients After Pulmonary Thromboendarterectomy

Kratzert

Boyd

Saggar

et al. 2019

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Neurologic Management Postoperative Physiologymentioning

confidence: 99%

Critical Care of Patients After Pulmonary Thromboendarterectomy

Kratzert

Boyd

Saggar

et al. 2019

Journal of Cardiothoracic and Vascular Anesthesia

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“…The presence of a PFO is about four times more frequent and hypoxemia is more severe in patients who are susceptible to high-altitude pulmonary edema than those living at high altitudes, who are resistant to this condition [ 63 ]. Interestingly, the presence of a PFO did not impact survival in primary pulmonary hypertension patients in one study [ 64 ]. The study’s authors speculated that the incidence of PFO increases in pulmonary hypertension patients with a more dilated and dysfunctional RV rather than it is congenital.…”

Section: Pfo-associated Medical Diseasesmentioning

confidence: 99%

Patent Foramen Ovale in Fetal Life, Infancy and Childhood

Das

2020

Medical Sciences

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A patent foramen ovale (PFO) is a common, incidental echocardiographic finding in otherwise healthy and asymptomatic infants and children. However, a variety of clinical conditions have been ascribed to the presence of a PFO in childhood, such as cryptogenic stroke, platypnea-orthodeoxia syndrome, decompression sickness and migraine, although the data on these are controversial and sometimes contradictory. This review discusses embryology and correlation with post-natal anatomy, anatomical variations of the atrial septum, diagnostic modalities in special circumstances of PFO associated clinical syndromes, and the role of PFO in congenital heart disease, pulmonary hypertension, dilated cardiomyopathy and heart failure in children who require an extracorporeal membrane oxygenator or ventricular assist device as life support.

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“…The course of the disease can be complicated by acute right ventricular (RV) failure, which is associated with a 30–40% mortality rate in the intensive care unit (ICU) ( 2 ). Patent foramen ovale (PFO) is frequently reported in this situation and creates a right-to-left (RL) shunt, reducing RV workload but leading to hypoxemia ( 3 ). Management of advanced RV dysfunction relies on the correction of a possible triggering factor, hemodynamic optimization (fluid volume management and pharmacological support), and the reduction of RV afterload using PAH drugs.…”

Section: Introductionmentioning

confidence: 99%

Case report: Extracorporeal life support as a successful bridge to recovery in an incident case of pulmonary arterial hypertension

Pequignot,

Chaouat,

Chabot

et al. 2024

Front. Med.

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Pulmonary arterial hypertension (PAH) is characterized by a progressive increase in pulmonary vascular resistance (PVR) due to vascular remodeling of the small pulmonary arteries. In advanced RV failure or severe hypoxemia, extra corporeal life support (ECLS) is now to be considered, with the objective to bridge patients back to their baseline clinical state while waiting or right after lung transplantation, or bridge to pharmacological optimization of PAH (i.e., bridge to recovery). We describe herein a case of a 30-year-old woman (gravida 6, para 6) with an incident case of heritable PAH revealed by refractory hypoxemia. Despite the use of mechanical ventilation and fluid optimization, the patient remained profoundly hypoxemic. ECLS was then initiated to avoid tissue hypoxia. The mechanical option chosen was peripheral femoro-femoral venoarterial extracorporeal membrane oxygen (VA-ECMO), percutaneously implanted. Due to the absence of evidence of chronic respiratory disease or chronic thromboembolic pulmonary hypertension, this severe pre-capillary pulmonary hypertension was attributed to PAH. Therefore, epoprostenol infusion and an association of oral treatments (bosentan and tadalafil) were administered. A dramatic improvement was observed, allowing decannulation 7 days after the initiation of pharmacological treatment. After 29 days, the patient was discharged from the hospital with epoprostenol, bosentan, and tadalafil. The assessment has been completed by positive research on mutations (c.741C > G, p.Tyr247) corresponding to a loss of function of the bone morphogenetic protein receptor 2 (BMPR2) gene. The final diagnosis was heritable PAH. The use of ECLS has been well demonstrated in patients with PAH complicated by acute RV failure or refractory hypoxemia in the “bridge-to-transplantation” strategy. Only a few reports have described the use of ECLS as a “bridge-to-recovery” with PAH drugs in untreated or undertreated PAH patients, but none has described such a rapid improvement with resolution of refractory hypoxemia. More studies are needed to assess the benefits and limitations of the “bridge-to-recovery” strategy and to identify the patients most likely to benefit from it.

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Effect of Patent Foramen Ovale in Patients With Pulmonary Hypertension

Cited by 13 publications

References 20 publications

Critical Care of Patients After Pulmonary Thromboendarterectomy

Critical Care of Patients After Pulmonary Thromboendarterectomy

Patent Foramen Ovale in Fetal Life, Infancy and Childhood

Case report: Extracorporeal life support as a successful bridge to recovery in an incident case of pulmonary arterial hypertension

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