{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T19:36:33Z","timestamp":1781638593638,"version":"3.54.5"},"reference-count":68,"publisher":"Texas Heart Institute Journal","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:p>Patent foramen ovale has been associated with multiple pulmonary diseases, such as pulmonary hypertension, platypnea-orthodeoxia syndrome, and chronic obstructive pulmonary disease. A connection between patent foramen ovale and chronic pulmonary disease was first described more than 2 decades ago in case reports associating patent foramen ovale with more severe hypoxemia than that expected based on the severity of the primary pulmonary disease. It has been suggested that patients with both chronic pulmonary disease and patent foramen ovale are subject to severe hypoxemia because of the right-to-left shunt. Furthermore, investigators have reported improved systemic oxygenation after patent foramen ovale closure in some patients with chronic pulmonary disease. This review focuses on the association between chronic pulmonary disease and patent foramen ovale and on the dynamics of a right-to-left shunt, and it considers the potential benefit of patent foramen ovale closure in patients who have hypoxemia that is excessive in relation to the degree of their pulmonary disease.<\/jats:p>","DOI":"10.14503\/thij-16-6027","type":"journal-article","created":{"date-parts":[[2017,6,30]],"date-time":"2017-06-30T21:32:37Z","timestamp":1498858357000},"page":"189-197","source":"Crossref","is-referenced-by-count":25,"title":["Potential Role of Patent Foramen Ovale in Exacerbating Hypoxemia in Chronic Pulmonary Disease"],"prefix":"10.14503","volume":"44","author":[{"given":"Michael E.","family":"Layoun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamil A.","family":"Aboulhosn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan M.","family":"Tobis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"5628","reference":[{"key":"i1526-6702-44-3-189-b1","series-title":"Large animal internal medicine","first-page":"452","year":"2002","unstructured":"Smith\n              B\n            , \n          editor. 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Rev Esp Cardiol2011;64(2):133\u20139."},{"issue":"4","key":"i1526-6702-44-3-189-b45","series-title":"JACC Cardiovasc Imaging","first-page":"343","article-title":"Sensitivity of transcranial Doppler versus intracardiac echocardiography in the detection of right-to-left shunt [published erratum appears in JACC Cardiovasc Imaging 2014;7(1):117]","volume":"3","year":"2010","unstructured":"Van\n              H\n            , PoommipanitP, ShalabyM, GevorgyanR, TsengCH, TobisJ.\n          Sensitivity of transcranial Doppler versus intracardiac echocardiography in the detection of right-to-left shunt [published erratum appears in JACC Cardiovasc Imaging 2014;7(1):117]. 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J Stroke Cerebrovasc Dis2009;18(5):343\u20138."},{"issue":"6","key":"i1526-6702-44-3-189-b51","series-title":"Echocardiography","first-page":"687","article-title":"Patent foramen ovale among patients with mild chronic obstructive pulmonary disease and unexplained hypoxia","volume":"27","year":"2010","unstructured":"Kilic\n              H\n            , BalciMM, AksoyMN, BilginE, GulsoyKG, YeterE, \n          et al. Patent foramen ovale among patients with mild chronic obstructive pulmonary disease and unexplained hypoxia. Echocardiography2010;27(6):687\u201390."},{"issue":"2","key":"i1526-6702-44-3-189-b52","series-title":"J COPD F","first-page":"185","article-title":"Significance of patent foramen ovale in patients with GOLD Stage II chronic obstructive pulmonary disease","volume":"1","year":"2014","unstructured":"Martolini\n              D\n            , TannerR, DaveyC, PatelMS, EliaD, PurcellH, \n          et al. Significance of patent foramen ovale in patients with GOLD Stage II chronic obstructive pulmonary disease. J COPD F2014;1(2):185\u201392. Available from: https:\/\/journal.copdfoundation.org\/Portals\/0\/JCOPDF\/Files\/Volume1-Issue2\/JCOPDF-2013-0003-Polkey.pdf."},{"issue":"5","key":"i1526-6702-44-3-189-b53","series-title":"Am J Respir Crit Care Med","first-page":"540","article-title":"Patent foramen ovale is not associated with hypoxemia in severe chronic obstructive pulmonary disease and does not impair exercise performance","volume":"189","year":"2014","unstructured":"Shaikh\n              ZF\n            , KellyJL, ShrikrishnaD, de VillaM, MullenMJ, HopkinsonNS, \n          et al. Patent foramen ovale is not associated with hypoxemia in severe chronic obstructive pulmonary disease and does not impair exercise performance. 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Am J Med1966;41(1):115\u201329."},{"issue":"4","key":"i1526-6702-44-3-189-b55","series-title":"Thorax","first-page":"327","article-title":"Serial studies of 100 patients with chronic airway obstruction in London and Chicago","volume":"22","year":"1967","unstructured":"Jones\n              NL\n            , BurrowsB, FletcherCM.\n          Serial studies of 100 patients with chronic airway obstruction in London and Chicago. Thorax1967;22(4):327\u201335."},{"issue":"1","key":"i1526-6702-44-3-189-b56","series-title":"Int J Chron Obstruct Pulmon Dis","first-page":"55","article-title":"Pulmonary hypertension associated with COPD","volume":"3","year":"2008","unstructured":"Elwing\n              J\n            , PanosRJ.\n          Pulmonary hypertension associated with COPD. 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J Appl Physiol Respir Environ Exerc Physiol1983;55(3):711\u20136."},{"issue":"1","key":"i1526-6702-44-3-189-b59","series-title":"J Appl Physiol (1985)","first-page":"390","article-title":"Hypoxic pulmonary vasoconstriction","volume":"98","year":"2005","unstructured":"Moudgil\n              R\n            , MichelakisED, ArcherSL.\n          Hypoxic pulmonary vasoconstriction. J Appl Physiol (1985)2005;98(1):390\u2013403."},{"issue":"2","key":"i1526-6702-44-3-189-b60","series-title":"Chronic Obstr Pulm Dis (Miami)","first-page":"151","article-title":"Patent foramen ovale in COPD and hypoxia: innocent bystander or novel therapeutic target?","volume":"1","year":"2014","unstructured":"Fenster\n              BE\n            , CarrollJD.\n          Patent foramen ovale in COPD and hypoxia: innocent bystander or novel therapeutic target?\n          Chronic Obstr Pulm Dis (Miami)\n          2014;1(2):151\u20134. Available from: https:\/\/journal.copdfoundation.org\/jcopdf\/id\/1038\/Patent-Foramen-Ovale-in-COPD-and-Hypoxia-Innocent-Bystander-or-Novel-Therapeutic-Target."},{"issue":"8","key":"i1526-6702-44-3-189-b61","series-title":"Am J Cardiol","first-page":"1258","article-title":"Effectiveness of percutaneous closure of patent foramen ovale for hypoxemia","volume":"112","year":"2013","unstructured":"Fenster\n              BE\n            , NguyenBH, BucknerJK, FreemanAM, CarrollJD.\n          Effectiveness of percutaneous closure of patent foramen ovale for hypoxemia. 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Sildenafil to facilitate weaning from inhaled nitric oxide and mechanical ventilation in a patient with severe secondary pulmonary hypertension and a patent foramen ovale. 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