Abstract
Although the association between patent foramen ovale (PFO) and stroke has been well established, PFO-mediated hypoxemia remains underrecognized and undertreated. PFO as a culprit of hypoxemia has been described in numerous observational studies, with a complete absence of published randomized trials evaluating the efficacy and safety of percutaneous PFO closure for treating pulmonary and nonpulmonary hypoxemic conditions that are attributed to right-to-left shunting (i.e., sleep apnea, platypnea-orthodeoxia, chronic obstructive pulmonary disease, pulmonary hypertension, pulmonary arteriovenous malformation, high-altitude pulmonary edema, and exercise desaturation). PFO-mediated hypoxemia occurs when deoxygenated venous blood enters and mixes with oxygenated systemic blood. This may result in profound hypoxemia out of proportion to underlying primary lung disease, even with normal right-sided cardiac pressures. Intracardiac right-to-left shunting can exacerbate underlying hypoxemic pulmonary disorders; in a subset of these patients, percutaneous PFO closure may improve symptoms and hypoxemia. This chapter will discuss the clinical association of PFO-mediated right-to-left shunting with hypoxemic medical conditions, and highlight the role of percutaneous device closure in treating the hypoxemia.
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