Patent Foramen Ovale Is an Important Predictor of Adverse Outcome in Patients With Major Pulmonary Embolism

Abstract

Background-Right-to-left shunt through a patent foramen ovale is frequently diagnosed by contrast echocardiography and can be particularly prominent in the presence of elevated pressures in the right side of the heart. Its prognostic significance in patients with pulmonary thromboembolism, however, is unknown. Methods and Results-The present prospective study included 139 consecutive patients with major pulmonary embolism diagnosed on the basis of clinical, echocardiographic, and cardiac catheterization criteria. All patients underwent contrast echocardiography at presentation. The end points of the study were overall mortality and complicated clinical course during the hospital stay defined as death, cerebral or peripheral arterial thromboembolism, major bleeding, or need for endotracheal intubation or cardiopulmonary resuscitation. Patent foramen ovale was diagnosed in 48 patients (35%). These patients had a death rate of 33% as opposed to 14% in patients with a negative echo-contrast examination (Pϭ.015). Logistic regression analysis demonstrated that the only independent predictors of mortality in the study population were a patent foramen ovale (odds ratio

Contemporary Management of Patent Foramen Ovale

“…12 In the context of pulmonary embolism, a 5-fold increased risk for mortality or systemic emboli was found in patients with a PFO. 13 A rare and peculiar syndrome is platypnea orthodeoxia. 14 It can be seen in elderly patients who become cyanotic and dyspneic while sitting up; these problems disappear when the patients are lying down.…”

Symptoms in the presence of a giant windsock eustachian valve remnant

“…However, recent assessments suggest that persistent EV may predispose to patency of the foramen ovale [3]. While a patent foramen ovale in patients with pulmonary embolic disease is associated with a ten-fold increase in death and a five-fold increase in the risk of adverse outcomes during the hospital stay [4], the added risk of a persistent EV may increase the risk of embolic thrombosis to the left atrium and arterial circulation [3].…”

A case of paradoxical embolism “in situ” associated with massive pulmonary embolism: Role of echocardiography

“…11 In 139 consecutive patients with PE, Konstantinides et al found that the presence of a patent foramen ovale doubles the mortality rate compared with patients with a PE and no shunt. 11 Thrombolytic therapy should be considered in patients with acute PE who have hemodynamic embarrassment or evidence of RV dysfunction.…”

“…11 In 139 consecutive patients with PE, Konstantinides et al found that the presence of a patent foramen ovale doubles the mortality rate compared with patients with a PE and no shunt. 11 Thrombolytic therapy should be considered in patients with acute PE who have hemodynamic embarrassment or evidence of RV dysfunction. [2][3][4] Nonrandomized registry data 12 have shown that thrombolytics decrease mortality when administered to hemodynamically stable patients with PE and RV dysfunction.…”