University Giessen Lung Center, University Hospital Giessen, Giessen, Germany;
J Appl Physiol (1985). 2013 Sep 1;115(5):704-7. doi: 10.1152/japplphysiol.00507.2012. Epub 2013 Jun 6.
A variation in right atrial and pulmonary arterial pressure might result in a shunt dynamic across a patent foramen ovale (PFO). In the present study we tested if peak exercise facilitates a restoration of right to left shunt (RLS) in stroke patients who demonstrated a functional PFO closure (no evidence of RLS across an initially demonstrated PFO). In stroke patients with PFO demonstrating a functional closure, the RLS was reassessed on peak exercise using contrast-enhanced transcranial Doppler sonography. The exercise procedure consisted of a cardiopulmonary exercise test with supplementary stress echocardiography for assessment of pulmonary circulation. Four stroke patients with initially PFO curtain pattern and a subsequent functional PFO closure (no evidence for RLS) underwent the procedure. In all four patients a RLS could be resurrected during peak physical exercise after a Valsalva strain. While in two patients peak exercise led to an RLS in a countable range of microembolic signals, in two patients a curtain pattern was obtained. One patient showed evidence for reoccurrence of RLS on peak exercise without a Valsalva strain. The patients with curtain pattern had a better peak exercise performance. Although the systolic pulmonary arterial pressure increased during exercise in all patients, there was no direct correlation with the detected RLS. After a functional PFO closure peak exercise combined with a Valsalva strain facilitates the reoccurrence of RLS in stroke patients.
右心房和肺动脉压力的变化可能导致卵圆孔未闭（PFO）出现分流动力学。在本研究中，我们测试了在显示功能性 PFO 关闭（最初显示的 PFO 无右向左分流（RLS）证据）的中风患者中，峰值运动是否促进 RLS 的恢复。在 PFO 显示功能性闭合的中风患者中，使用对比增强经颅多普勒超声检查在峰值运动时重新评估 RLS。运动程序包括心肺运动测试和补充应激超声心动图评估肺循环。最初 PFO 幕式和随后功能性 PFO 关闭（无 RLS 证据）的 4 例中风患者进行了该程序。在所有 4 例患者中，在瓦尔萨尔瓦应变后，在峰值体力活动期间可重现 RLS。在 2 例患者中，峰值运动导致微栓塞信号的 RLS 可计数，而在 2 例患者中获得幕式。一名患者在无瓦尔萨尔瓦应变的情况下，在峰值运动时出现 RLS 再发的证据。幕式的患者峰值运动表现更好。尽管所有患者在运动期间收缩期肺动脉压升高，但与检测到的 RLS 没有直接相关性。在功能性 PFO 关闭后，峰值运动结合瓦尔萨尔瓦应变有助于中风患者 RLS 的再发。
