Effect of Patent Foramen Ovale in Patients With Pulmonary Hypertension.

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2018-08

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Abstract

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.

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10.1016/j.amjcard.2018.04.014

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Sharan, Lauren, Kathryn Stackhouse, Jordan D Awerbach, Thomas M Bashore and Richard A Krasuski (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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Scholars@Duke

Bashore

Thomas Michael Bashore

Professor Emeritus 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 Journal of Cardiology, Cardiac Catheterization and Intervention, the Journal of Heart Valve Disease, the American Heart Journal, Cardiology Today, the Journal of Invasive Cardiology and the Journal of the American College of Cardiology. He was formerly director of the Diagnostic Cardiac Catheterization Laboratories for 10 years, and then the Director of the Cardiology Fellowship Training Program for 12 years. He is currently the Clinical Chief of the Division of Cardiology. He is a member and/or chairman of numerous committees of the American College of Cardiology and author of over 250 manuscripts, over 70 book chapters and reviews and 3 books. Dr. J. Kevin Harrison, Dr. Andrew Wang, Dr. Tom Gehrig, Dr. Todd Kiefer, Dr. Michael Sketch and Dr. Cary Ward complement the research team along with a variety of research personnel. Currently research is focused on the percutaneous treatment of structural heart disease and adult congenital heart disease.

Krasuski

Richard Andrew Krasuski

Professor of Medicine

Dr. Richard Krasuski is Director of the Adult Congenital Heart Center at Duke University Medical Center, the Director of Hemodynamic Research, and the Medical Director of the CTEPH Program. He is considered a thought leader in the fields of pulmonary hypertension and congenital heart disease. His research focus is in epidemiologic and clinical studies involving patients with pulmonary hypertension and patients with congenital heart disease. He is involved in multiple multicenter studies through the Alliance for Adult Research in Congenital Cardiology (AARCC). He has also helped to develop multiple research databases in these patient populations. He is Co-PI in the upcoming EPIPHANY Study examining the impact of medical and transcatheter interventions on RV-PA coupling in patients with chronic thromboembolic pulmonary hypertension. Over his career he has mentored over 80 students, residents and fellows and has published over 300 peer reviewed publications, book chapters and meeting abstracts. He is also the Chief Editor of Advances in Pulmonary Hypertension and on the editorial boards of several leading medical journals.


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