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To the Editor: In their case-control study, Dr Allemann and colleagues¹ identified an association between patent foramen ovale (PFO) and susceptibility to high-altitude pulmonary edema (HAPE) in mountaineers. In HAPE-susceptible participants, they observed low arterial oxygen saturation that preceded the onset of clinical HAPE. Their study suggests that intracardiac right-to-left shunting through a PFO is partly responsible for this hypoxemia. We believe that subclinical pulmonary edema may also contribute to the early hypoxemia observed in this group and suggest a means of evaluating this in future studies.

The ascent to Capanna Regina Margherita induces subclinical pulmonary edema, even in those persons not developing clinical HAPE.^2-3 Allemann et al describe no attempt to determine the degree of pulmonary edema present when their participants' oxygen saturations were measured. Persons who subsequently developed clinical HAPE may have already incurred significant, if subclinical, pulmonary edema when their oxygen saturations were measured. Correspondingly, a portion . . . [Full Text of this Article]

Peter J. Fagenholz, MD
pfagenholz@partners.org
Department of Surgery

N. Stuart Harris, MD, MFA
Department of Emergency Medicine
Massachusetts General Hospital
Boston

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