Hemodynamic and respiratory factors that influence the opening of patent foramen ovale in mechanically ventilated patients

Anna Vavlitou, G. Minas, S. Zannetos, T. Kyprianou, M. Tsagourias, D. Matamis

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Patent foramen ovale (PFO) is an anatomic variant that may lead to several pathological conditions, notably right to left shunt, paradoxical embolism, hypoxemia, and cerebral fat embolism. Mechanical positive pressure ventilation may increase the prevalence of PFO opening in Intensive Care Unit (ICU) patients; however, the respiratory and hemodynamic determinants of PFO opening have been poorly investigated. Contrast-enhanced transesophageal echocardiogram (ce-TEE) is considered the gold standard for PFO detection. We prospectively performed a multicenter study using ce-TEE in order to determine the respiratory and hemodynamic factors that may lead to PFO opening. Methods: One hundred and eight consecutive ICU adult patients under mechanical ventilation from three tertiary care hospitals, were included in the study. A standard multiplane ce-TEE was performed, and the dimensions and function of the right and left ventricle were studied. In each patient, the right ventricle (RV) end-diastolic area, RV end-systolic area, left ventricle (LV) end-diastolic area, and LV ejection fraction were measured using the modified Simpson’s rule and the four-chamber view. At least three bubble tests were performed to detect PFO opening. Ventilatory parameters such as tidal volume, plateau pressure, static lung compliance, and positive end-expiratory pressure were recorded during the bubble test. Results: Data for 81 men and 27 women were analyzed. PFO was detected in 27 % of the study population. Statistical significance was found between the presence of PFO and plateau pressure (odds ratio 3.421, 95 % CI: 1.2-9.4, p =0.017). Additionally, the presence of right ventricular dilatation (RV>LV) was strongly associated with PFO opening (odds ratio 3.163, 95 % CI: 1.2-8.075, p =0.018). Conclusions: In this group of mechanically ventilated, critically ill adult patients, right ventricular dilatation and plateau pressure above 26 mmHg were significantly associated with foramen ovale opening.

Original languageEnglish
Pages (from-to)209-213
Number of pages5
JournalHippokratia
Volume20
Issue number3
Publication statusPublished - 2016

Keywords

  • Mechanical ventilation
  • Patent foramen ovale
  • Plateau pressure
  • Positive end-expiratory pressure
  • Right ventricle

Fingerprint

Dive into the research topics of 'Hemodynamic and respiratory factors that influence the opening of patent foramen ovale in mechanically ventilated patients'. Together they form a unique fingerprint.

Cite this