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

Brief Reports1 May 1994Use of Inhaled Nitric Oxide To Reverse Flow through a Patent Foramen Ovale during Pulmonary EmbolismPhilippe Estagnasie, MD, Genevieve Le Bourdelles, MD, Laurence Mier, MD, Francois Coste, MD, and Didier Dreyfuss, MDPhilippe Estagnasie, MDFrom Hopital Louis Mourier, Colombes, France., Genevieve Le Bourdelles, MDFrom Hopital Louis Mourier, Colombes, France., Laurence Mier, MDFrom Hopital Louis Mourier, Colombes, France., Francois Coste, MDFrom Hopital Louis Mourier, Colombes, France., and Didier Dreyfuss, MDFrom Hopital Louis Mourier, Colombes, France.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-120-9-199405010-00007 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail 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 [4-7].Case ReportA 74-year-old ...References1. Moser KM. Pulmonary embolism. In: Murray JF, Nadel JA. Textbook of Respiratory Medicine. Philadelphia: W.B. Saunders Company; 1988:1299-327. Google Scholar2. Konstadt SN, Louie EK, Black S, Rao TLK, Scanlon P. Intraoperative detection of patent foramen ovale by transesophageal echocardiography. Anesthesiology. 1991; 74:212-6. Google Scholar3. Bridges ND, Hellenbrand W, Latson L, Filiano J, Newburger JW, Lock JE. Transcatheter closure of patent foramen ovale after presumed paradoxical embolism. Circulation. 1992; 86:1902-8. Google Scholar4. Frostell C, Fratacci MD, Wain JC, Jones R, Zapol WM. Inhaled nitric oxide. A selective pulmonary vasodilatator reversing hypoxic pulmonary vasoconstriction. Circulation. 1991; 83:2038-47. Google Scholar5. Roberts JD, Lang P, Bigatello LM, Vlahakes GJ, Zapol WM. Inhaled nitric oxide in congenital heart disease. Circulation. 1993; 87:447-53. Google Scholar6. Pepke-Zaba J, Higenbottam TW, Dinh-Xuan AT, Stone D, Wallwork J. Inhaled nitric oxide as a cause of selective pulmonary vasodilatation in pulmonary hypertension. Lancet. 1991; 338:1173-4. Google Scholar7. Rossaint R, Falke KJ, Lopez F, Slama K, Pison U, Zappol WM. Inhaled nitric oxide for the adult respiratory distress syndrome. N Engl J Med. 1993; 328:399-405. Google Scholar8. Miller GAH, Sutton GC, Kerr IH, Gibson RV, Honey M. Comparison of streptokinase and heparin in treatment of isolated acute massive pulmonary embolism. Br Med J. 1971; 2:681-4. Google Scholar9. Hart RG. Cardiogenic embolism to the brain. Lancet. 1992; 339:589-94. Google Scholar10. Harpaz D, Bezante GP, Meltzer RS. Contrast echocardiography: The state of the art. Cardiovascular Imaging. 1991; 3:251-6. Google Scholar11. Dantzker DR, Bower JS. Alterations in gas exchange following pulmonary thromboembolism. Chest. 1982; 81:495-501. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Hopital Louis Mourier, Colombes, France.Corresponding Author: Didier Dreyfuss, MD, Service de Reanimation Medicale, Hopital Louis Mourier, 92700 Colombes et Faculte Xavier Bichat, 75018 Paris, France. 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