Abstract 15081: Increment of Right Atrial Pressure Influenced Occurrence of Right to Left Flow Patent Foramen Ovale and Its Relationship with Paradoxical Cerebral Infarction in Subjects with Chronic Thromboembolic Pulmonary Hypertension Considering Presence of Interatrial Septal Aneurysm
Purpose: To determine the clinical significance of a patent foramen ovale (PFO) with flow directional information and interatrial septal aneurysm (IASA) by multislice CT in subjects with pulmonary thromboembolism (PTE), we compared its incidence with right heart catheterization (RHC) findings and the occurrence of cerebral infarction (CI) detected by MRI.
Materials and Methods: A retrospective analysis of 33 consecutive subjects (17 female; age 56±10 years) with proven chronic PTE, undergoing CT, RHC, and brain MRI. The presence of PFO with flow directional information and IASA was evaluated by enhanced CT.
Results: PFO and IASA were detected in 13 subjects (10 right to left, 3 left to right) and 4 subjects (3 right, 1 left), respectively. Deep venous thrombus (DVT) was found in 58% and implantation of an inferior vena cava filter was performed in 97%. CI occurred in 5 subjects (all asymptomatic, age 57±10years, not significantly different from those without CI, 56±10years). Of the 10 subjects with right to left PFO, 20% had CI, not significantly different from those without PFO (15%). Of the 13 subjects with any directional PFO, 38% had CI, significantly more than those without PFO (0%, P<0.01). Of the 4 subjects with IAPA, 25% had CI. The frequencies of DVT in the lower extremities, male gender, coronary risk factors, and serum levels of plasma brain natriuretic peptides, were no different between the groups. In logistic regression models for predicting the occurrence of any directional PFO or right to left PFO, right atrial pressure (RAP) from RHC was found to be associated with an increased incidence of any directional PFO or right to left PFO (odds ratios 1.34 (95% confidence interval 1.001-1.803), and 1.69 (1.09-2.63), respectively, both P<0.05).
Conclusions: Increased RAP from RHC may be associated with an increased incidence of any directional PFO and right to left PFO. Also, PFO may be associated with an increased occurrence of paradoxical CI in subjects with chronic PTE.
- © 2011 by American Heart Association, Inc.