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Provoked exercise desaturation in patent foramen ovale and impact of percutaneous closure.

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Date
2012-04
Authors
Devendra, Ganesh P
Rane, Ajinkya A
Krasuski, Richard A
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Abstract
OBJECTIVES: This study was designed to assess the prevalence of provoked exercise desaturation (PED) in patients with patent foramen ovale (PFO) referred for cardiovascular evaluation and to evaluate the impact of PFO closure. BACKGROUND: Platypnea orthodeoxia syndrome is a rare, mechanistically obscure consequence of PFO that results in oxygen desaturation during postural changes. In our clinical experience, however, it is far less common than desaturation during exercise. METHODS: This was a single-center prospective study of 50 patients with newly diagnosed PFO. Each patient underwent standardized assessment for arterial oxygen saturation with pulse oximetry during postural changes and stair climbing exercise. Provoked exercise desaturation was defined as a desaturation of at least 8% from baseline to <90%. All patients who underwent closure were reevaluated 3 months after the procedure. Those with baseline PED were similarly reassessed for desaturation at follow-up. RESULTS: Mean age of the cohort was 46 ± 17 years, 74% were female, 30% had migraines, and 48% had experienced a cerebrovascular event. Seventeen patients (34%) demonstrated PED. Provoked exercise desaturation patients seemed demographically similar to non-PED patients. Ten PED patients underwent PFO closure (2 surgical, and 8 percutaneous). Drop in oxygen saturation was improved by an average of 10.1 ± 4.2% after closure (p < 0.001), and New York Heart Association functional class improved by a median of 1.5 classes (interquartile range: 0.75 to 2.00, p = 0.008). CONCLUSIONS: 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.
Type
Journal article
Subject
Adult
Aged
Biomarkers
Cardiac Catheterization
Chi-Square Distribution
Echocardiography, Doppler
Exercise Test
Exercise Tolerance
Female
Foramen Ovale, Patent
Humans
Male
Middle Aged
Ohio
Oximetry
Oxygen
Predictive Value of Tests
Prospective Studies
Prosthesis Design
Recovery of Function
Septal Occluder Device
Time Factors
Treatment Outcome
Permalink
https://hdl.handle.net/10161/11017
Published Version (Please cite this version)
10.1016/j.jcin.2012.01.011
Publication Info
Devendra, Ganesh P; Rane, Ajinkya A; & Krasuski, Richard A (2012). Provoked exercise desaturation in patent foramen ovale and impact of percutaneous closure. JACC Cardiovasc Interv, 5(4). pp. 416-419. 10.1016/j.jcin.2012.01.011. Retrieved from https://hdl.handle.net/10161/11017.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Krasuski

Richard Andrew Krasuski

Professor of Medicine
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