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To the Editor: Dr Allemann and colleagues¹ reported a significant association between a PFO and HAPE. As they note, the cause-and-effect relationship between these 2 abnormalities is not clear. The patient description cited as evidence of PFO being a cause for susceptibility to HAPE does not present a strong argument in support of this hypothesis. This patient was treated with calcium channel blockers in addition to the closure of his PFO, and calcium channel blockers have been shown to be highly effective for preventing HAPE.²

The authors also discuss the possibility that the excessive hypoxic pulmonary vasoconstriction associated with susceptibility to HAPE on occasional exposures to high altitude may have resulted in a persistent reopening of a previously closed foramen ovale. Other data support the hypothesis of PFO being a consequence of high pulmonary artery pressure. Several groups have demonstrated that susceptibility to HAPE is also associated with an abnormal . . . [Full Text of this Article]

Christoph Dehnert, MD; Peter Bärtsch, MD
peter.bartsch@med.uni-heidelberg.de
Medical University Clinic
Department of Internal Medicine VII
Division of Sports Medicine

Ekkehard Grünig, MD; Derliz Mereles, MD
Medical University Clinic
Department of Internal Medicine III
Division of Cardiology
Heidelberg, Germany

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