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clinical investigations: Cardiovascular and Cardiac Surgery: Journal ArticleThe Prevalence and Significance of a Patent Foramen Ovale in Pulmonary Hypertension
Section snippets
Patients
Fifty-eight consecutive patients with pulmonary hypertension (44 female, 14 male), with a mean age of 42 ± 11 (range, 15 to 69) years, were studied. All patients were evaluated for the etiology of their pulmonary hypertension based on the protocol used in the National Institutes of Health Registry on Primary Pulmonary Hypertension.2 Pulmonary hypertension was diagnosed as primary in 40 patients (69 percent) and secondary in 18 (31 percent).
Patent Foramen Ovale Detection
Transesophageal echocardiography was performed using a
RESULTS
A PFO was present in 26 percent (15 of 58) of all patients studied, 25 percent (10 of 40) of the patients with PPH, and in 28 percent (5 of 18) of the patients with secondary pulmonary hypertension.
Hemodynamics, resting arterial oxygen saturation levels with patients breathing room air, and exercise times for the groups with and without a PFO are given in Table 1. The patients studied had severe pulmonary hypertension with a mean pulmonary artery pressure of 55 ± 15 mm Hg, pulmonary vascular
DISCUSSION
A PFO has been reported in 25 to 35 percent of normal patients at autopsy.5 Several retrospective studies have reported a prevalence from 12 to 31 percent in patients with PPH.1, 6, 7 The methods of detection, however, include right-sided heart catheterization and transthoracic echocardiography which, due to technical limitations, tend to underreport the actual prevalence.3 Recently, contrast transesophageal echocardiography was reported to be possibly the most sensitive and specific test for
APPENDIX
A proportional hazards model is used to predict survival of primary pulmonary hypertension (PPH) patients. The probability of a given PPH patient surviving past t years, given hemodynamic variables collected at baseline, is where t ranges from one to five years, and the hemodynamic variables are x = mean pulmonary artery pressure, y = mean right atrial pressure, and z = cardiac index.
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