Patent foramen ovale diagnosis: The importance of provocative maneuvers

S. Mongodi; G. Via; M. Riccardi; G. Tavazzi; A. M. D'Armini; M. Maurelli; A. Braschi; F. Mojoli

doi:10.1002/jcu.22383 [doi]

Patent foramen ovale diagnosis: The importance of provocative maneuvers

S. Mongodi, G. Via, M. Riccardi, G. Tavazzi, A. M. D'Armini, M. Maurelli, A. Braschi, F. Mojoli

IRCCS Fondazione Policlinico San Matteo

Research output: Contribution to journal › Article › peer-review

Abstract

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. (c) 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:58-61, 2017.

Original language	English
Pages (from-to)	58-61
Number of pages	4
Journal	Journal of Clinical Ultrasound
Volume	45
Issue number	1
DOIs	https://doi.org/10.1002/jcu.22383 [doi]
Publication status	Published - Jan 1 2017

Keywords

Aged
Echocardiography, Transesophageal/methods
Foramen Ovale, Patent/diagnostic imaging/physiopathology
Humans
Male
Positive-Pressure Respiration
Ultrasonography, Doppler, Color/methods
Valsalva Maneuver
echocardiography
paradoxical response to positive end-expiratory pressure
patent foramen ovale
provocative maneuvers
right-to-left shunt

Access to Document

10.1002/jcu.22383 [doi]

Cite this

@article{17d4244d305f4a52b4a83f6ad548a6f2,

title = "Patent foramen ovale diagnosis: The importance of provocative maneuvers",

abstract = "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. (c) 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:58-61, 2017.",

keywords = "Aged, Echocardiography, Transesophageal/methods, Foramen Ovale, Patent/diagnostic imaging/physiopathology, Humans, Male, Positive-Pressure Respiration, Ultrasonography, Doppler, Color/methods, Valsalva Maneuver, echocardiography, paradoxical response to positive end-expiratory pressure, patent foramen ovale, provocative maneuvers, right-to-left shunt",

author = "S. Mongodi and G. Via and M. Riccardi and G. Tavazzi and D'Armini, {A. M.} and M. Maurelli and A. Braschi and F. Mojoli",

note = "LR: 20180202; CI: (c) 2016; JID: 0401663; OTO: NOTNLM; 2016/03/02 00:00 [received]; 2016/06/15 00:00 [revised]; 2016/06/17 00:00 [accepted]; 2016/07/23 06:00 [pubmed]; 2018/02/03 06:00 [medline]; 2016/07/23 06:00 [entrez]; ppublish",

year = "2017",

month = jan,

day = "1",

doi = "10.1002/jcu.22383 [doi]",

language = "English",

volume = "45",

pages = "58--61",

journal = "Journal of Clinical Ultrasound",

issn = "0091-2751",

publisher = "John Wiley and Sons Inc.",

number = "1",

}

TY - JOUR

T1 - Patent foramen ovale diagnosis: The importance of provocative maneuvers

AU - Mongodi, S.

AU - Via, G.

AU - Riccardi, M.

AU - Tavazzi, G.

AU - D'Armini, A. M.

AU - Maurelli, M.

AU - Braschi, A.

AU - Mojoli, F.

N1 - LR: 20180202; CI: (c) 2016; JID: 0401663; OTO: NOTNLM; 2016/03/02 00:00 [received]; 2016/06/15 00:00 [revised]; 2016/06/17 00:00 [accepted]; 2016/07/23 06:00 [pubmed]; 2018/02/03 06:00 [medline]; 2016/07/23 06:00 [entrez]; ppublish

PY - 2017/1/1

Y1 - 2017/1/1

N2 - 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. (c) 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:58-61, 2017.

AB - 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. (c) 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:58-61, 2017.

KW - Aged

KW - Echocardiography, Transesophageal/methods

KW - Foramen Ovale, Patent/diagnostic imaging/physiopathology

KW - Humans

KW - Male

KW - Positive-Pressure Respiration

KW - Ultrasonography, Doppler, Color/methods

KW - Valsalva Maneuver

KW - echocardiography

KW - paradoxical response to positive end-expiratory pressure

KW - patent foramen ovale

KW - provocative maneuvers

KW - right-to-left shunt

U2 - 10.1002/jcu.22383 [doi]

DO - 10.1002/jcu.22383 [doi]

M3 - Article

SN - 0091-2751

VL - 45

SP - 58

EP - 61

JO - Journal of Clinical Ultrasound

JF - Journal of Clinical Ultrasound

IS - 1

ER -

Patent foramen ovale diagnosis: The importance of provocative maneuvers

Abstract

Keywords

Access to Document

Fingerprint

Cite this