Patent foramen ovale diagnosis: The importance of provocative maneuvers

Patent foramen ovale (PFO) is a frequent congenital anomaly, but massive right-to-left shunt (RTLS) is normally prevented by higher pressures in left heart chambers. However, mechanical ventilation with positive end-expiratory pressure (PEEP) can significantly increase right atrial pressure, accentu...

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Bibliographic Details
Published in:Journal of clinical ultrasound : JCU 2017, Vol.45 (1), p.58-61
Main Authors: Mongodi, Silvia, Via, Gabriele, Riccardi, Mariachiara, Tavazzi, Guido, D'Armini, Andrea Maria, Maurelli, Marco, Braschi, Antonio, Mojoli, Francesco
Format: Report
Language:English
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Summary:Patent foramen ovale (PFO) is a frequent congenital anomaly, but massive right-to-left shunt (RTLS) is normally prevented by higher pressures in left heart chambers. However, mechanical ventilation with positive end-expiratory pressure (PEEP) can significantly increase right atrial pressure, accentuating the RTLS, mainly after major cardiothoracic surgery. We report a patient admitted to the intensive care unit after cardiac surgery. Pre- and intraoperative transesophageal echocardiography only described an aneurysmal interatrial septum with no shunt. However, high-PEEP ventilation induced a paradoxical response with life-threatening hypoxemia, triggering further echocardiographic evaluation, revealing massive RTLS across a stretch PFO. Provocative maneuvers (Valsalva/PEEP) significantly increase echocardiographic sensitivity, unmasking silent PFO. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:58-61, 2017.
ISSN:1097-0096
DOI:10.1002/jcu.22383