@article {Perkins:2008:0020-1324:462,
	author = "Perkins, Linda A. and Costa, Steven M. and Boethel, Carl D. and Lawrence, Mark E.",
	title = "Hypoxemia Secondary to Right-to-Left Interatrial Shunt Through a Patent Foramen Ovale in a Patient With an Elevated Right Hemidiaphragm",
	journal = "Respiratory Care",
	volume = "53",
	number = "4",
	year = "2008",
	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.",
	pages = "462-465",
	url = "http://www.ingentaconnect.com/content/jrcc/rc/2008/00000053/00000004/art00007",
	keyword = "CARDIAC SHUNT, SEPTAL OCCLUSION DEVICE, DIAPHRAGM PARALYSIS, REFRACTORY HYPOXEMIA, DYSPNEA, PATENT FORAMEN OVALE"
}