ACKNOWLEDGMENTS
Conflict of Interest: The editor in chief has reviewed the
conflict of interest checklist provided by the authors and
has determined that the authors have no financial or any
other kind of personal conflicts with this paper.
Author Contributions: Anne Forest: Concept and
design, acquisition of participants and data, analysis and
interpretation of data, and preparation of manuscript.
He´le`ne Le Petitcorps: Acquisition of subjects and data.
Najid Hammoudi and Jacques Boddaert: Analysis and
interpretation of data and preparation of manuscript.
Gilles Montalescot: Analysis and interpretation of data.
Patrick Ray and Marc Verny: Preparation of manuscript.
Sponsor’s Role: No sponsor role in the design, methods,
recruitment, data collection, analysis, or preparation
of paper.
chest auscultation was clear; physical examination was
normal; oxygen saturation was less than 90%, requiring
oxygen at 15 L/min; and blood pressure and pulses were
constantly normal. Blood gases were pH 7.52, PCO2
23 mmHg, PO2 40 mmHg, and HCO3– 21 mmol/L. Electrocardiogram
was unchanged, N-terminal prohormone of
brain natriuretic peptide was 366 ng/mL, troponin was
negative, chest X-ray was normal, and a contrast-enhanced
computed tomography scan excluded pulmonary embolism
and recurrent pneumonia. Right to left shunt was suspected,
and transthoracic echocardiography (TTE) with
bubble contrast was performed. A broad right–left intracardiac
shunt was documented, the left ventricle had normal
function, and there was no valvular disease. A
transesophageal echo (TEE) that supplemented the exploration
confirmed a patent foramen ovale (PFO) (Figure 1)
and showed the feasibility of percutaneous closure. An
atrial septum aneurysm and a Eustachian valve were also
identified.
A decision was made to close the PFO for the following
reasons. First, acute hypoxemia resulted in functional
limitation. Second, his wife reported a history of recurrent
similar episodes (4–5 per year) associated with dizziness
and possibly implicated in recurrent falls. Coughing and
defecating precipitated these episodes. Last, these weakness
episodes led to frequent emergency visits. A percutaneous
transcatheter device closure was successfully performed for
the PFO, a femoral hematoma (puncture site) requiring a
blood transfusion complicated the procedure. Despite this
complication, clinical course was favorable, he returned
home, hypoxemia episodes regressed, and no reccurrence
was reported 9 months later.
On physical examination, his temperature was 40°C,
blood pressure 110/50 mmHg, heart rate 104/min, and
oxygen saturation 86%. Blood gases were pH 7.44, partial