Transesophageal echocardiographic demonstration of distinct mechanisms for right to left shunting across a patent foramen ovale in the absence of pulmonary hypertension
D Langholz,
EK Louie,
SN Konstadt,
TL Rao,
and
PJ Scanlon
Department of Medicine, Loyola University Medical Center, Maywood, Illinois 60153.
The optimal visualization of the atrial septum and fossa ovalis by transesophageal echocardiography was utilized to demonstrate saline contrast transit across the atrial septum and to relate it to the motion of the flap valve (septum primum) of the fossa ovalis. In three cases, three distinct mechanisms of right to left interatrial shunting in the absence of right ventricular systolic hypertension were identified: 1) transient spontaneous reversal of the left to right atrial pressure differential with each cardiac cycle; 2) sustained elevation of right atrial pressure above left atrial pressure induced by respiratory maneuvers; and 3) aberrant flow redirection across the foramen ovale due to a large right atrial mass. Any of these three mechanisms may be operative during paradoxic embolism in the absence of elevation of right ventricular pressures.
This article has been cited by other articles:

|
 |

|
 |
 
R. K. Mareedu, M. S. Shah, J. E. Mesa, and C. S. McCauley
Percutaneous Closure of Patent Foramen Ovale: A Case Series and Literature Review
Clin. Med. Res.,
December 1, 2007;
5(4):
218 - 226.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. R. Sukernik and E. Bennett-Guerrero
The Incidental Finding of a Patent Foramen Ovale During Cardiac Surgery: Should It Always Be Repaired? A Core Review
Anesth. Analg.,
September 1, 2007;
105(3):
602 - 610.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. S. Darchis, P. V. Ennezat, C. Charbonnel, J. M. Aubert, X. Gonin, J. L. Auffray, J. J. Bauchart, T. Le Tourneau, C. Rey, F. Godart, et al.
Hemidiaphragmatic paralysis: An underestimated etiology of right-to-left shunt through patent foramen ovale?
Eur Heart J Cardiovasc Imaging,
August 1, 2007;
8(4):
259 - 264.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. Homma and R. L. Sacco
Patent Foramen Ovale and Stroke
Circulation,
August 16, 2005;
112(7):
1063 - 1072.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. Zanchetta, G. Rigatelli, and S. Y. Ho
A Mystery Featuring Right-to-Left Shunting Despite Normal Intracardiac Pressure
Chest,
August 1, 2005;
128(2):
998 - 1002.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. Ghamande, R. Ramsey, J. F. Rhodes, and J. K. Stoller
Right Hemidiaphragmatic Elevation With a Right-to-Left Interatrial Shunt Through a Patent Foramen Ovale : A Case Report and Literature Review
Chest,
December 1, 2001;
120(6):
2094 - 2096.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. De Castro, D. Cartoni, M. Fiorelli, M. Rasura, A. Anzini, E. M. Zanette, M. Beccia, C. Colonnese, F. Fedele, C. Fieschi, et al.
Morphological and Functional Characteristics of Patent Foramen Ovale and Their Embolic Implications
Stroke,
October 1, 2000;
31(10):
2407 - 2413.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. Faller, R. Kessler, A. Chaouat, M. Ehrhart, H. Petit, and E. Weitzenblum
Platypnea-Orthodeoxia Syndrome Related to an Aortic Aneurysm Combined With an Aneurysm of the Atrial Septum
Chest,
August 1, 2000;
118(2):
553 - 557.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
T. O. Cheng, G. P. Anzola, M. Magoni, M. Guindani, L. Rozzini, and G. D. Volta
Potential source of cerebral embolism in migraine with aura: a transcranial Doppler study
Neurology,
December 1, 1999;
53(9):
2211 - 2211.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. J. Schwarze, D. Sander, C. Kukla, I. Wittich, V. L. Babikian, and J. Klingelhofer
Methodological Parameters Influence the Detection of Right-to-Left Shunts by Contrast Transcranial Doppler Ultrasonography
Stroke,
June 1, 1999;
30(6):
1234 - 1239.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. Konstantinides, A. Geibel, W. Kasper, M. Olschewski, L. Blumel, and H. Just
Patent Foramen Ovale Is an Important Predictor of Adverse Outcome in Patients With Major Pulmonary Embolism
Circulation,
May 19, 1998;
97(19):
1946 - 1951.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
E. M. Zanette, G. Mancini, S. De Castro, M. Solaro, D. Cartoni, and F. Chiarotti
Patent Foramen Ovale and Transcranial Doppler: Comparison of Different Procedures
Stroke,
December 1, 1996;
27(12):
2251 - 2255.
[Abstract]
[Full Text]
|
 |
|

|
 |

|
 |
 
C. Vicol, V. Davov, and E. Struck
Paradoxical embolism in the presence of right-to-left shunt due to tricuspid occlusion
Ann. Thorac. Surg.,
October 1, 1995;
60(4):
1111 - 1112.
[Abstract]
[PDF]
|
 |
|

|
 |

|
 |
 
W. E. Dear, P. Chen, E. Barasch, H. V. Anderson, A. T. Varughese, and M. P. Macris
Sixty-Eight-Year-Old Woman With Intermittent Hypoxemia
Circulation,
April 15, 1995;
91(8):
2284 - 2289.
[Full Text]
|
 |
|
|