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Use of Inhaled Nitric Oxide To Reverse Flow through a Patent Foramen Ovale during Pulmonary Embolism

Philippe Estagnasie, MD; Genevieve Le Bourdelles, MD; Laurence Mier, MD; Francois Coste, MD; and Didier Dreyfuss, MD
[+] Article and Author Information

From Hopital Louis Mourier, Colombes, France. Requests for Reprints: Didier Dreyfuss, MD, Service de Reanimation Medicale, Hopital Louis Mourier, 92700 Colombes et Faculte Xavier Bichat, 75018 Paris, France.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1994;120(9):757-759. doi:10.7326/0003-4819-120-9-199405010-00007
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The presence of a patent foramen ovale during pulmonary embolism may promote right-to-left shunting when right atrial pressure exceeds that in the left atrium. This may cause severe hypoxemia and paradoxical embolism [1]. The diagnosis of this complication has benefited from contrast transesophageal echocardiography [2]. Invasive procedures, such as transcatheter or surgical closure, are usually required [3] but may not be easily done in unstable patients. Reversing the right-to-left atrial pressure gradient may promote closure of the patent foramen ovale. We report an example of this reversal using inhaled nitric oxide, a potent pulmonary vasodilator [47].

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Figure 1.
Transesophageal echocardiography in the four-chamber plane. Top left.arrowsLATop rightRALVBottom left

Atrial septal aneurysm ( ) bulging into the left atrium ( ). . Contrast echoes (microbubbles) massively moving from the right atrium ( ) to the left atrium and then to the left ventricle ( ). . Inhaled nitric oxide completely abolished the passage of microbubbles from right to left.

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