Provoked Exercise Desaturation in Patent Foramen Ovale and Impact of Percutaneous Closure

Abstract

One-third of patients referred for assessment of PFO experience oxygen desaturation during stair exercise. Closure of PFO seems to ameliorate this phenomenon and improve functional status.

A 58-year-old woman with hypoxia, hypoxaemia, a hole in the heart and a … herring! Intracardiac or extracardiac shunt? That is the question!

“…The rationale for percutaneous device closure is supported by the work of Fenster et al ,8 Devendra et al 9 and El Tahlawi et al ,10 who reported significant symptomatic and functional status improvement in their respective cohorts with this therapy. The common denominator in their series was the absence of significant pulmonary hypertension in recipients of percutaneous closure devices.…”

The brain's heart — Therapeutic opportunities for patent foramen ovale (PFO) and neurovascular disease

“…(Sacco, 1997; Mas, 2001; Donnan & Davis, 2004; Furlan, 2004; Tong & Becker, 2004; Ferguson, 2006; Bedard, 2007; Belvis, 2007; Furlan, 2007; Messe & Kasner, 2008; Windecker & Meier, 2008; Mazzucco, 2009; Mattle, 2010; Calvert, 2011) While establishing the “proper treatment” is beyond the scope of this review and current data, this lack of clinical consensus likely originates from complexities of PFO-related injury itself, as a myriad of associated risks differ widely between individual patients, and further novel risk factors are just beginning to be recognized. (Yip, 1997; Petty, 1999; Jacobs, 2002; Schneider, 2004; Handke, 2007; Silver, 2007; Ning, 2008; Ning, 2009; Agarwal & Kapadia, 2010; Devendra & Krasuski, 2011; Haghikia, 2011; Lau, 2011; Petrea, 2011; Devendra, 2012; La Spina, 2012)…”

“…(Lovering, 2011) While this difference was not demonstrated during exercise in this particular study, another study showed that endovascular PFO closure improved exercise capacity and reduced exercise-induced hypoxemia. (Devendra & Krasuski, 2011) In this innovative study, “provoked exercise desaturation (PED)” was well characterized as “arterial desaturation during assessment of at least 8% to a value less than 90%” during ambulation up and down 4 flights of stairs. Of interest, one third of patients with PFO-related stroke had oxygen desaturation during stair exercise.…”

“…At 3 months post PFO closure, oxygen saturation during exercise and clinical functional status dramatically improved for these patients with provoked exercise desaturation (oxygen saturation- +10.1%+/−4.2%, p<0.001; NYHA functional +1.5 classes, interquartile range: 0.75 to 2, p = 0.008). (Devendra, 2012) Such a simple, inexpensive functional and physiological clinical assessment, which can be easily performed in the office, is highly promising in helping to refine patient selection for those who will benefit the most from PFO closure. Indeed, in the clinical setting, patients post-PFO closure frequently report improved general exercise tolerance and better vascular perfusion to the extremities.…”

Some Air for Closure of the Patent Foramen Ovale

“…What has not been known but is nicely shown by Devendra et al (1) in this issue of JACC: Cardiovascular Interventions is that it may do so much more commonly than previously thought. What has not been known but is nicely shown by Devendra et al (1) in this issue of JACC: Cardiovascular Interventions is that it may do so much more commonly than previously thought.…”