Patent Foramen Ovale Diagnosis: The Importance of Provocative Maneuvers

作者：Mongodi Silvia^*; Via Gabriele; Riccardi Mariachiara; Tavazzi Guido; D'Armini Andrea Maria; Maurelli Marco; Braschi Antonio; Mojoli Francesco

来源：Journal of Clinical Ultrasound, 2017, 45(1): 58-61.

DOI：10.1002/jcu.22383

• patent foramen ovale
• provocative maneuvers
• right-to-left shunt
• echocardiography
• paradoxical response to positive end-expiratory pressure

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.

• 出版日期2017-1