Possible PFO with right left shunt and borderline pulmonary hypertension

Presented at hospital with a possible TIA.  Neurological tests were negative for stroke. (MRI/CAT) Carotid echo clear.  Echo with saline was performed.  Unfortunately the results of this test were not sent to cardiologist that I followed up with. :-(  One year later my internist at my physical picked up on this.

Echo results were right to left shunt seen by agitated saline suggesting trans pulmonary transit.
Right ventricular cavity borderline enlarged
Right ventricular systolic pressure estimated to be 30-40 mm.
Right ventricular function is normal.

My question.  It has been a year since this was done with no follow up.  I have continued to have TIA symptoms (tingling in the arms/face, fatigue, etc.) but dismissed them because I was led to believe I got the "all clear" from my doctors.

I an a 45 yr old female with no other medical issues. Good health. (or so I thought)

My cardiologist is well known teaching institution so I trust his reputation.  Though someone in his office really dropped the ball here.

WHAT DOES ALL THIS MEAN?  He asked me to come in monday to schedule a TEE and stress echo.  Am I going to drop dead over the week-end?  This has me majorly stressed out!!

Any input is greatly appreciated!!

[kenkeith]

Q: Echo results were right to left shunt seen by agitated saline suggesting trans pulmonary transit.
Right ventricular cavity borderline enlarged
Right ventricular systolic pressure estimated to be 30-40 mm.
Right ventricular function is normal".

>>>>>I can provide some insight into what the report describes, and you won't have a fatal event in the short term.

Usually, with PFO there is a shunt from the left to right chamber because the left side normally has the highest intr-chamber pressure.  Going from the left to right lower chamber mixes good oxygenated blood with the blood that is going to be pumped to the lungs to be oxygenated, and there is very little medical significance,

But when the left ventricle's oxygenated blood is mixed with the right chambers "dirty" blood reduces the oxygenated value of the blood circulated into the system.  The underly cause can be the higher than normal pulmonary artery pressure with increase the right ventricle's pressure and enlarge the chamber size.  Then this increased pressure can/will shunt some blood to the left side.

An estimated pulmonary artery systolic pressure greater than or equal to 40 mm Hg by echocardiography is considered significant pulmonary hypertension, and that could indicate the high pressure is due to the resistence from  blood clots (emboli) in the lungs, or pulmonary artery thombrosis (clot) of that vessel.

A TEE provides a different view of the interested location that the chest echo cannot properly image.  According to the echo the right chamber is slightly dilated, pumping normally, and there is some resistance that the right ventricle pumps against.

Hope this helps, and if you have any further questions or comments you are invited to respond.  Take care, and I wish you well going forward.

Ken

[RCARMONA]

OK MY SON IS 20 YRS. OLD AND HAS HAD EPISODES OF SYNCOPE AND FATIGUE, CHEST PAIN, SEVERE DIZZINESS AND CYANOSIS! HE HAD SEEN A CARDIOLOGISTS WHEN HE WAS 10 WITH SAME SYMPTOMS DOC SAID HE HAD TACHYCARDIA WITH A DYSMORPHIC AORTIC VALVE???AS AN ADULT HE HAS BEEN DIAGNOSED WITH A RIGHT TO LEFT SHUNT WITH VENTRICULAR ENLARGMENT NOTHING IS WRONG WITH THE AORTIC VALVE CAN YOU TELL ME HOW THIS MISTAKE COULD HAVE BEEN MISDIAGNOSED??? AND HOW CAN THIS BE REPAIRED???

[RCARMONA]

Really scared and want answers as to my sons prognosis???