Authors: Perkins, Linda A.¹; Costa, Steven M.²; Boethel, Carl D.²; Lawrence, Mark E.²

Source: Respiratory Care, Volume 53, Number 4, April 2008 , pp. 462-465(4)

Publisher: The Journal Respiratory Care Company

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; SEPTAL OCCLUSION DEVICE; DIAPHRAGM PARALYSIS; REFRACTORY HYPOXEMIA; DYSPNEA; PATENT FORAMEN OVALE

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: 2008-04-01

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