Patent foramen ovale and high-altitude pulmonary edema

Détails

ID Serval
serval:BIB_C22C06FDADB5
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Patent foramen ovale and high-altitude pulmonary edema
Périodique
JAMA
Auteur(s)
Allemann  Y., Hutter  D., Lipp  E., Sartori  C., Duplain  H., Egli  M., Cook  S., Scherrer  U., Seiler  C.
ISSN
1538-3598 (Electronic)
Statut éditorial
Publié
Date de publication
12/2006
Volume
296
Numéro
24
Pages
2954-8
Notes
Journal Article
Research Support, Non-U.S. Gov't --- Old month value: Dec 27
Résumé
CONTEXT: Individuals susceptible to high-altitude pulmonary edema (HAPE) are characterized by exaggerated pulmonary hypertension and arterial hypoxemia at high altitude, but the underlying mechanism is incompletely understood. Anecdotal evidence suggests that shunting across a patent foramen ovale (PFO) may exacerbate hypoxemia in HAPE. OBJECTIVE: We hypothesized that PFO is more frequent in HAPE-susceptible individuals and may contribute to more severe arterial hypoxemia at high altitude. DESIGN, SETTING, AND PARTICIPANTS: Case-control study of 16 HAPE-susceptible participants and 19 mountaineers resistant to this condition (repeated climbing to peaks above 4000 m and no symptoms of HAPE). MAIN OUTCOME MEASURES: Presence of PFO determined by transesophageal echocardiography, estimated pulmonary artery pressure by Doppler echocardiography, and arterial oxygen saturation measured by pulse oximetry in HAPE-susceptible and HAPE-resistant participants at low (550 m) and high altitude (4559 m). RESULTS: The frequency of PFO was more than 4 times higher in HAPE-susceptible than in HAPE-resistant participants, both at low altitude (56% vs 11%, P = .004; odds ratio [OR], 10.9 [95% confidence interval (CI), 1.9-64.0]) and high altitude (69% vs 16%, P = .001; OR, 11.7 [95% CI, 2.3-59.5]). At high altitude, mean (SD) arterial oxygen saturation prior to the onset of pulmonary edema was significantly lower in HAPE-susceptible participants than in the control group (73% [10%] vs 83% [7%], P = .001). Moreover, in the HAPE-susceptible group, participants with a large PFO had more severe arterial hypoxemia (65% [6%] vs 77% [8%], P = .02) than those with smaller or no PFO. CONCLUSIONS: Patent foramen ovale was roughly 4 times more frequent in HAPE-susceptible mountaineers than in participants resistant to this condition. At high altitude, HAPE-susceptible participants with a large PFO had more severe hypoxemia. We speculate that at high altitude, a large PFO may contribute to exaggerated arterial hypoxemia and facilitate HAPE.
Mots-clé
Adult *Altitude Altitude Sickness/*physiopathology Anoxemia/etiology/*physiopathology Blood Flow Velocity Case-Control Studies Coronary Circulation Echocardiography, Doppler Echocardiography, Transesophageal Female Heart Septal Defects, Atrial/complications/*physiopathology/ultrasonography Humans Hypertension, Pulmonary/*physiopathology Male Middle Aged Mountaineering Oximetry Pulmonary Artery Pulmonary Edema/*etiology
Pubmed
Web of science
Open Access
Oui
Création de la notice
25/01/2008 14:44
Dernière modification de la notice
09/05/2019 0:48
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