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In Reply: Drs Fagenholz and Harris suggest that in addition to right-to-left shunting through a PFO, subclinical pulmonary edema may have contributed to the observed exaggerated hypoxemia in HAPE-susceptible participants in our study; they propose the comet-tail technique of chest ultrasonography as a means to test this hypothesis in future studies. Subclinical pulmonary edema in climbers remains controversial and relies on the assumption that an increased closing volume at high altitude indicates increased pulmonary extravascular fluid¹ rather than a nonspecific alteration related to exercise or subclinical bronchoconstriction. More important, pulmonary extravascular fluid accumulation may be present in the vast majority of healthy recreational climbers at our study site.¹ It therefore appears unlikely that differences in arterial oxygenation between HAPE-susceptible and HAPE-resistant participants in our study were related to extravascular fluid accumulation, since this phenomenon, if existent, would be expected to occur with similar frequency in both groups. The suggestion to . . . [Full Text of this Article]

Yves Allemann, MD
yves.allemann@insel.ch

Christian Seiler, MD
University Hospital
Swiss Cardiovascular Center Bern
Bern, Switzerland

Urs Scherrer, MD; Claudio Sartori, MD
Department of Medicine and Botnar Center for Extreme Medicine
Centre Hospitalier Universitaire Vaudois
Lausanne, Switzerland

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