Case Report
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Cardiol. Jul 26, 2013; 5(7): 254-257
Published online Jul 26, 2013. doi: 10.4330/wjc.v5.i7.254
Hypoxemia without persistent right-to-left pressure gradient across a patent foramen ovale: A clinical challenge
Sadip Pant, Kevin Hayes, Abhishek Deshmukh, David L Rutlen
Sadip Pant, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
Kevin Hayes, Abhishek Deshmukh, David L Rutlen, Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
Author contributions: Pant S conceived the study, participated in its design and coordination and helped to draft the manuscript; Hayes K and Deshmukh A participated in drafting of manuscript; Deshmukh A contributed to the literature review; Rutlen DL contributed to the case analysis, and editing.
Correspondence to: Sadip Pant, MD, Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W Markham, Little Rock, AR 72205, United States. spant@uams.edu
Telephone: + 1-501-4059729 Fax: +1-501-4059438
Received: February 9, 2013
Revised: April 25, 2013
Accepted: June 1, 2013
Published online: July 26, 2013
Abstract

Patent foramen ovale (PFO) closure for systemic hypoxemia is controversial. The first systematic, albeit retrospective, study was recently presented which showed good procedural and clinical success for PFO closure for this indication. We present a case of acute right to left intra-cardiac shunt across PFO where the shunting is not persistent. Hence making a decision on PFO closure based on the aforementioned promising trial may not have been the right decision for the patient. This case highlights that the decision on PFO closure for such indication needs to be individualized. We also review the sparse literature on PFO closure for this indication and discuss how the decision making for such indication needs to be individualized.

Keywords: Patent foramen ovale, Hypoxemia, Right-to-left shunt, Shunt closure, Pulmonary embolism, Atrial septal defect

Core tip: Patent foramen ovale (PFO) is a common, yet benign entity most of the time. Rarely, it is known to play role in causation of stroke, migraine and even rarely, profound hypoxemia. We report a rare case of severe hypoxemia due to PFO where the shunting is not persistent. We also review the sparse literature on PFO closure for this indication and discuss how the decision making for such indication needs to be individualized.