Percutaneous balloon catheter closure of a patent foramen ovale in a patient with pulmonary disease, profound hypoxemia, and normal right heart pressures

John J. Allan, Carlos Marinelli, Kevin C Dellsperger, Michael D. Winniford

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Right-to-left intracardiac shunting across a patent foramen ovale (PFO) has been reported in patients with pulmonary embolism, fight ventricular (RV) infarction, positive pressure ventilation with positive end-expiratory pressure, heart failure with left ventricular assist devices, cardiac tamponade, and unilateral diaphragmatic paralysis. The primary driving force for these shunts is a reduction in the compliance of the pulmonary bed or fight ventricle; right atrial pressure is usually elevated and pulmonary hypertension is frequently present. Significant shunting and hypoxemia are unusual in the absence of these diseases. We encountered a patient with normal pulmonary pressures, severe hypoxemia, pulmonary disease, and intracardiac shunting across a PFO in whom it was difficult to determine how great a role intracardiac shunting was playing in his hypoxemia. To assess this, we performed percutaneous balloon catheter occlusion of the PFO, using transthoracic echocardiography with contrast to confirm closure of the PFO. Therapeutic balloon occlusion has been reported in severe hypoxemia due to shunting across a PFO in a patient with RV infarction. Our case is unique, however, in two respects. First, this patient had normal right-sided cardiac pressures and normal RV function and, thus, no obvious driving force for a significant right-to-left shunt. Second, transthoracic echocardiography with contrast was used before and after balloon inflation to confirm closure of the PFO. This technique helped to answer the important clinical question of whether surgical closure of the PFO in this patient with both lung disease and intracardiac shunting would significantly improve his oxygenation.

Original languageEnglish (US)
Pages (from-to)307-309
Number of pages3
JournalClinical Cardiology
Volume20
Issue number3
DOIs
StatePublished - Jan 1 1997

Fingerprint

Patent Foramen Ovale
Lung Diseases
Catheters
Pressure
Balloon Occlusion
Positive-Pressure Respiration
Infarction
Echocardiography
Therapeutic Occlusion
Respiratory Paralysis
Lung
Cardiac Tamponade
Heart-Assist Devices
Atrial Pressure
Economic Inflation
Hypoxia
Pulmonary Embolism
Pulmonary Hypertension
Heart Failure

Keywords

  • balloon occlusion
  • contrast
  • hypoxemia
  • intracardiac shunting
  • patent foramen ovale
  • transthoracic echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Percutaneous balloon catheter closure of a patent foramen ovale in a patient with pulmonary disease, profound hypoxemia, and normal right heart pressures. / Allan, John J.; Marinelli, Carlos; Dellsperger, Kevin C; Winniford, Michael D.

In: Clinical Cardiology, Vol. 20, No. 3, 01.01.1997, p. 307-309.

Research output: Contribution to journalArticle

Allan, John J. ; Marinelli, Carlos ; Dellsperger, Kevin C ; Winniford, Michael D. / Percutaneous balloon catheter closure of a patent foramen ovale in a patient with pulmonary disease, profound hypoxemia, and normal right heart pressures. In: Clinical Cardiology. 1997 ; Vol. 20, No. 3. pp. 307-309.
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