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Hypoxemia Secondary to Right-to-Left Interatrial Shunt Through a Patent Foramen Ovale in a Patient With an Elevated Right Hemidiaphragm

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Abstract:

Though uncommon, right-to-left shunt through a patent foramen ovale with normal right-side pressure and with a normal interatrial pressure gradient has been reported. The speculated pathophysiology is attributed to directional blood flow streaming from the vena cava to the left atrium. Hypoxemia secondary to right-to-left shunt with normal pulmonary artery pressure has been extensively documented after right pneumonectomy. Five prior cases have documented hypoxemia secondary to a right-to-left shunt through a patent foramen ovale in the presence of an elevated right hemidiaphragm. This is the sixth documented case of right-to-left shunt through a patent foramen ovale in the presence of an elevated right hemidiaphragm with a similar presentation in which closure of the patent foramen ovale resulted in resolution of hypoxemia.

Keywords: CARDIAC SHUNT; DIAPHRAGM PARALYSIS; DYSPNEA; PATENT FORAMEN OVALE; REFRACTORY HYPOXEMIA; SEPTAL OCCLUSION DEVICE

Document Type: Case Report

Affiliations: 1: Texas A&M University System Health Science Center, Temple, Texas; Division of Pulmonary and Critical Care, Department of Internal Medicine, University of South Carolina, Columbia, South Carolina 2: Scott and White Memorial Hospital and Clinic, Scott, Sherwood, Brindley Foundation, The Texas A&M University System Health Science Center College of Medicine, Temple, Texas

Publication date: April 1, 2008

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