Effect of Patent Foramen Ovale in Patients With Pulmonary Hypertension.
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Septostomy reduces right ventricular (RV) workload at the expense of hypoxemia in patients with advanced pulmonary hypertension (PH). A patent foramen ovale (PFO) may serve as a "natural" septostomy, but the incidence and impact of a PFO in PH remains uncertain. We prospectively examined echocardiograms in 404 PH patients referred for initial hemodynamic assessment. Patients included had saline bubble injection and if negative repeatinjection after Valsalva maneuver. Echocardiographic and hemodynamic data were examined. Survival was modeled using Kaplan-Meier method. Eisenmenger syndrome or known atrial shunts other than PFO were excluded: 292 patients met entry criteria. A PFO was identified in 16.8% of the entire cohort, 22.9% of pulmonary arterial hypertension (PAH) patients, and 8.6% of Dana Point group 2 PH patients. Right atrial to pulmonary capillary wedge pressure difference was lowest in the latter group (-7.9 ± 7.1 vs -1.7 ± 5.5 mm Hg for all others, p <0.01). Patients with a PFO were younger (53.9 vs 58.6 years, p = 0.02). A PFO was more often present with moderately or severely dilated (p = 0.01) or dysfunctional (p = 0.03) RVs. Six year survival was unchanged by PFO presence for all patients, including those with PAH. Proportional hazards analysis found only age and functional class independently predicted survival (p <0.01). A PFO is identified less often in Dana Point group 2 PH, likely due to inability of Valsalva maneuver to overcome right atrial to pulmonary capillary wedge pressure difference. In conclusion, the incidence of a PFO in the PH population increases with more dilated and dysfunctional RVs, suggesting that the PFO may be stretched open rather than congenital. The presence of a PFO does not impact survival in PH or PAH.
SubjectScience & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Published Version (Please cite this version)10.1016/j.amjcard.2018.04.014
Publication InfoAwerbach, Jordan; Bashore, Thomas; Krasuski, Richard; Sharan, Lauren; & Stackhouse, Kathryn (2018). Effect of Patent Foramen Ovale in Patients With Pulmonary Hypertension. The American journal of cardiology, 122(3). pp. 505-510. 10.1016/j.amjcard.2018.04.014. Retrieved from https://hdl.handle.net/10161/17946.
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Tom Anstrom Fellow in Adult Congenital Heart Disease
Professor of Medicine
The major areas of research involve mostly hemodynamic and imaging research: 1. Valvular heart disease. 2. Adult congenital heart disease. 3. Pulmonary Hypertension. 4. Complex cardiovascular problems. The Valvular Disease Program and Adult Congenital Program are nationally recognized, and many trainees have gone on to academic careers at a number of universities. Dr. Bashore is now or recently has been on the Editorial Boards of Circulation, the American Jou
Professor of Medicine
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