Nguyen S, Leroy S, Bautin N, de Tauriac P, Chevalon B, Rey C, Remy-Jardin M, Wallaert B
Service de pneumologie et immuno-allergologie, Hôpital Calmette, CHRU Lille, France.
Rev Mal Respir. 2007 May;24(5):631-4. doi: 10.1016/s0761-8425(07)91132-8.
The association between idiopathic pulmonary fibrosis and patent foramen ovale has rarely been described.
We report the cases of two patients, 72 and 59 years old, who presented with refractory hypoxemia in the context of pulmonary fibrosis. The hypoxemia was due to a right-to-left shunt through a patent foramen ovale (PFO), diagnosed by transoesophageal contrast echocardiography. The closure of the PFO allowed a decrease in the oxygen requirement in the first case: from 8 l/min to 3 l/min (PaO2 80 mmHg), and in the second case oxygen therapy could be stopped (PaO2 76 mmHg on room air). Right-to left shunts by PFO are usually associated with pulmonary arterial hypertension (systolic pulmonary arterial pressure at 70 mmHg for case 1), but in some cases the pulmonary artery pressure is normal (case 2), the shunt being due to an anatomical conformation.
These two cases underline the importance of diagnosing right-to-left shunts in patients who have pulmonary fibrosis with severe hypoxemia, in order to reduce their oxygen needs.
特发性肺纤维化与卵圆孔未闭之间的关联鲜有报道。
我们报告了两名患者的病例，分别为72岁和59岁，他们在肺纤维化背景下出现难治性低氧血症。低氧血症是由于经食管对比超声心动图诊断出的通过卵圆孔未闭（PFO）的右向左分流所致。在第一例中，PFO封堵使氧需求降低：从8升/分钟降至3升/分钟（动脉血氧分压80 mmHg），在第二例中可以停止氧疗（室内空气下动脉血氧分压76 mmHg）。PFO导致的右向左分流通常与肺动脉高压相关（第一例患者收缩期肺动脉压为70 mmHg），但在某些情况下肺动脉压正常（第二例），分流是由于解剖结构所致。
这两例病例强调了在患有严重低氧血症的肺纤维化患者中诊断右向左分流以降低其氧需求的重要性。
