Low DLCO

[anonymous3344]

I am a 20 yr old female and very active. i swam year round for 8 yrs and last year i had an 8.5mm pfo/asd closure. Since then i have had shortness of breath only with extreme exercise like when racing. I am thin and have low blood pressure so i get dizzy upon standing. I have had a million tests for my heart and lungs and the only thing abnormal was my DLCO which was 68-70% of normal. My right heart catheter showed a pulmonary pressure of 23. The doctors are having a hard time figuring it out and they already ruled out any autoimmune diseases. Other than that i have some stomach allergies but i feel fine otherwise. I never have shortness of breath with moderate exercise or daily activity. I am going to have a right heart catheter again with exercise since they are thinking pulmonary hypertension with exercise. Do you think this is the most likely answer? If so is it possible that the pfo caused the damage to my lungs and maybe it wont progress since the hole is now closed?

[anonymous3344]

thank you for your opinion. i posted a new question on the website that gives more details about the testing i have done

[David Tinkelman, M.D.]

The borderline low diffusion capacity is of concern.  The first step would be to confirm the validity of the result (68-70%) as this test requires careful attention to detail or the result may be falsely reduced.  The information you provide provides no clues regarding the cause of a truly low DLCO.  I could find no evidence of a cause and effect relationship between the DLCO and a PFO.  

I believe that the cause of your alleged “low blood pressure” deserves further investigation.  Unusual causes would include adrenal insufficiency and autonomic nervous system disorders.

Another possibility is that the septal defect repair is no longer intact and that, either with or without pulmonary hypertension you are experiencing right to left shunting of blood with severe exercise.  If the right heart cath does not reveal a cause, you might want to request a second opinion at an institution that specializes in the diagnosis of exercise related symptoms such as your shortness of breath and low blood pressure.

I would be most interested in the results of the right heart catheterization.

Good luck