Major pulmonary embolism and hemodynamic stability from shunting through a patent foramen ovale.
While the combination of a patent foramen ovale (PFO) and thromboembolic disease is thought to portend increased morbidity and mortality, PFO presence in the setting of major pulmonary embolism (PE) may serve as a means to rescue patients from immediate hemodynamic collapse and death. We present two patients with major pulmonary embolism and right-to-left shunting consistent with PFO as seen on transthoracic echocardiography. In the setting of major PE, PFO may prevent acute right ventricular failure by acting as a 'pop-off' valve, alleviating increased ventricular pressures; but concomitantly portend deleterious effects in the form of paradoxical embolism and intractable hypoxemia.
Moua
Teng
T
Department of Internal Medicine, Division of Pulmonary/Critical Care, University of Wisconsin Hospitals and Clinics, Madison, WI, USA. t.moua@hosp.wisc.edu
Wood
Kenneth E
KE
Atwater
Brett D
BD
Runo
James R
JR
D000369:Aged, 80 and over; D015150:Echocardiography, Doppler; D005260:Female; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D011859:Radiography; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016306:Vena Cava Filters
D010959:Tissue Plasminogen Activator