Effect of body position and oxygen tension on foramen ovale recruitment

Kayla L Moses; Arij G Beshish; Nicole Heinowski; Kim R Baker; David F Pegelow; Marlowe W Eldridge; Melissa L Bates

doi:10.1152/ajpregu.00263.2014

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Effect of body position and oxygen tension on foramen ovale recruitment

Journal article

Open access

Peer reviewed

Effect of body position and oxygen tension on foramen ovale recruitment

Kayla L Moses, Arij G Beshish, Nicole Heinowski, Kim R Baker, David F Pegelow, Marlowe W Eldridge and Melissa L Bates

American journal of physiology. Regulatory, integrative and comparative physiology, Vol.308(1), pp.R28-R33

01/01/2015

DOI: 10.1152/ajpregu.00263.2014

PMCID: PMC4281682

PMID: 25394826

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Abstract

While there is an increased prevalence of stroke at altitude in individuals who are considered to be low risk for thrombotic events, it is uncertain how venous thrombi reach the brain. The patent foramen ovale (PFO) is a recruitable intracardiac shunt between the right and left atrium. We aimed to determine whether body position and oxygen tension affect blood flow through the PFO in healthy adults. We hypothesized that hypoxia and body positions that promote right atrial filling would independently recruit the PFO. Subjects with a PFO (n = 11) performed 11 trials, combining four different fractions of inhaled oxygen (FiO₂) (1.0, 0.21, 0.15, and 0.10) and three positions (upright, supine, and 45° head down), with the exception of FiO₂ = 0.10, while 45° head down. After 5 min in each position, breathing the prescribed oxygen tension, saline bubbles were injected into an antecubital vein and a four-chamber echocardiogram was obtained to evaluate PFO recruitment. We observed a high incidence of PFO recruitment in all conditions, with increased recruitment in response to severe hypoxia and some contribution of body position at moderate levels of hypoxia. We suspect that increased pulmonary vascular pressure, secondary to hypoxia-induced pulmonary vasoconstriction, increased right atrial pressure enough to recruit the PFO. Additionally, we hypothesize that the minor increase in breathing resistance that was added by the mouthpiece, used during experimental trials, affected intrathoracic pressure and venous return sufficiently to recruit the PFO.

Injections, Intravenous

Humans

Male

Stroke - physiopathology

Posture

Young Adult

Arterial Pressure

Foramen Ovale, Patent - physiopathology

Time Factors

Contrast Media - administration & dosage

Adult

Female

Supine Position

Severity of Illness Index

Vascular Resistance

Echocardiography

Vasoconstriction

Foramen Ovale, Patent - blood

Sodium Chloride - administration & dosage

Atrial Function, Right

Hypoxia - complications

Pulmonary Artery - physiopathology

Biomarkers - blood

Oxygen - blood

Pulmonary Circulation

Hypoxia - blood

Stroke - etiology

Foramen Ovale, Patent - diagnostic imaging

Adolescent

Hypoxia - physiopathology

Foramen Ovale, Patent - complications

Head-Down Tilt

Hemodynamics

Altitude

Details

Title: Subtitle: Effect of body position and oxygen tension on foramen ovale recruitment
Creators: Kayla L Moses - Department of Pediatrics, Critical Care Division, and the John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
Arij G Beshish - Department of Pediatrics, Critical Care Division, and the John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Nicole Heinowski - Department of Pediatrics, Critical Care Division, and the John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Kim R Baker - Adult Echocardiography Laboratory, University of Wisconsin Hospital and Clinics, Madison, Wisconsin; and
David F Pegelow - Department of Pediatrics, Critical Care Division, and the John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Marlowe W Eldridge - Department of Pediatrics, Critical Care Division, and the John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
Melissa L Bates - Department of Pediatrics, Critical Care Division, and the John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa melissa-bates@uiowa.edu
Resource Type: Journal article
Publication Details: American journal of physiology. Regulatory, integrative and comparative physiology, Vol.308(1), pp.R28-R33
DOI: 10.1152/ajpregu.00263.2014
PMID: 25394826
PMCID: PMC4281682
NLM abbreviation: Am J Physiol Regul Integr Comp Physiol
ISSN: 0363-6119
eISSN: 1522-1490
Publisher: American Physiological Society; United States
Grant note: 5R01HL-086897 / NHLBI NIH HHS 5T32HL-007654 / NHLBI NIH HHS R01 HL086897 / NHLBI NIH HHS
Language: English
Date published: 01/01/2015
Academic Unit: Stead Family Department of Pediatrics; Health, Sport, and Human Physiology ; Internal Medicine
Record Identifier: 9984002487702771

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