Chest
Volume 104, Issue 6, December 1993, Pages 1673-1675
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clinical investigations: Cardiovascular and Cardiac Surgery: Journal Article
The Prevalence and Significance of a Patent Foramen Ovale in Pulmonary Hypertension

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In order to determine the prevalence and significance of a patent foramen ovale (PFO) in pulmonary hypertension, 58 patients were studied with transesophageal echocardiography, right-sided heart catheterization, and exercise testing. In order to examine if a PFO might be associated with a better outcome, survival was estimated, based on a formula derived from the National Institutes of Health Primary Pulmonary Hypertension Registry, for the patients with primary pulmonary hypertension (PPH). A PFO was found in 26 percent (15 of 58) of all patients studied, 25 percent (10 of 40) of those with PPH, and 28 percent (5 of 18) of those with secondary pulmonary hypertension. We found no significant difference in any hemodynamic variable or exercise tolerance between the patients with and without a PFO, or for subsets of patients with primary and secondary pulmonary hypertension. We also found no significant difference in the 1-, 2-, 3-, 4-, or 5-year estimated survival, for the patients with PPH between those with and without a PFO. The prevalence of a PFO in pulmonary hypertension appears similar to the normal population. A PFO provides no detectable influence on resting hemodynamics or exercise tolerance in patients with pulmonary hypertension and is not clearly associated with patients expected to survive longer.

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 PD(t,x,y,z)=[H(t)]A(x,y,z), where H(t)=0.880.14t+0.01A2,A(x,y,z)=e0.007325x+0.0526y0.3275z, 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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