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- W203940149 abstract "To the Editor:I read with interest the case report by Maraj et al 1 of hypoxia due to patent foramen ovale (PFO) in the absence of pulmonary hypertension. I wish to make a few comments.First, PFO is indeed a frequent anatomic finding in normal people, more than the figure of 20% as reported by the authors. It was present in 27.3% of normal subjects in a large autopsy series published in 1984. 2Second, in addition to the 2 postulated mechanisms for right-to-left shunting via a PFO in the absence of pulmonary hypertension as discussed by the authors, I would like to mention a 3rd possibility—a persistent Eustachian valve. This was present in the case we reported in 1983. 3Third, platypnea-orthodeoxia is a relatively uncommon but serious syndrome of arterial hypoxia and breathlessness in the upright position caused by interatrial or intrapulmonary shunting. The most common cause is an interatrial right-to-left shunt through either a PFO or an atrial septal defect. 4 Platypnea-orthodeoxia can be explained on the basis of positional modification of abnormal shunting. Standing upright can stretch the interatrial communication, be it a PFO or an atrial septal defect, thus allowing more streaming of venous blood from the inferior vena cava through the defect, whether or not a persistent Eustachian valve coexists.Fourth, besides platypnea-orthodeoxia, PFO may also be responsible for paradoxical embolism in the presence of either established or induced pulmonary hypertension. 5 The diagnosis of paradoxical embolism can now be made antemortem. 5–7Fifth, when treatment is indicated for PFO, nowadays it can be done nonsurgically by transcatheter closure. 8,9 This approach avoids the morbidity, mortality, and increased expenses associated with open heart surgery. 10,11 As we enter the new millennium, most patients with PFO can be treated in the cardiac catheterization laboratory instead of in the operating room. 12" @default.
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- W203940149 date "2000-01-01" @default.
- W203940149 modified "2023-09-23" @default.
- W203940149 title "The significance of a patent foramen ovale." @default.
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