Patent Foramen Ovale and Hypoxemia

作者：Mohammad K. Mojadidi, Juan Carlos Ruiz, Jason Chertoff, Muhammad Omer Zaman, Islam Y. Elgendy, Mahmoud Ahmed, Mohammad A. Al‐Ani, Akram Y. Elgendy, Nimesh Kirit Patel, Ghanshyam Palamaner Subash Shantha, Jonathan M. Tobis, Bernhard Meier · 发表于：Cardiology in Review · 年份：2018 · DOI：10.1097/crd.0000000000000205 · 被引用次数：94 · 研究领域：Cardiovascular and Diving-Related Complications、Neuroscience of respiration and sleep、High Altitude and Hypoxia

Patent foramen ovale (PFO), an embryonic remnant of the fetal circulation, is present in 20-25% of adults. Although recent observational studies and clinical trials have established the link between PFO-mediated right-to-left shunting with cryptogenic stroke and migraine with aura, the role of a PFO in exacerbating hypoxemic medical conditions (ie, sleep apnea, chronic obstructive pulmonary disease, pulmonary hypertension, platypnea-orthodeoxia, pulmonary arteriovenous malformation, high-altitude pulmonary edema, and exercise desaturation) remains less understood. PFO-mediated hypoxemia occurs when deoxygenated venous blood from the right atrium enters and mixes with oxygenated arterial blood in the left atrium. Patients with an intracardiac right-to-left shunt may have profound hypoxemia out of proportion to underlying primary lung disease, even in the presence of normal right-sided pressures. The presence of right-to-left cardiac shunting can exacerbate the degree of hypoxemia in patients with underlying pulmonary disorders. In a subset of these patients, percutaneous PFO closure may result in marked improvement in dyspnea and hypoxemia. This review discusses the association between PFO-mediated right-to-left shunting with medical conditions associated with hypoxemia and explores the role of percutaneous PFO closure in alleviating the hypoxemia.