Right-to-left interatrial shunt despite normal pulmonary artery pressure. Anatomical implications

Soriano, Carlos J.; Balaguer, José Ramón; Romero-Lluch, Ana R.; Pérez-Boscá, José Leandro; Pomar, Francisco; Sánchez, José Pardo; Payá, Rafael

doi:10.1016/j.ijcard.2005.08.073

Cited by 9 publications

(5 citation statements)

References 11 publications

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“…The described hypothesis for the mechanism of the reopening of the PFO is the deviation of the mediastinum toward the right side, which occurs after right pneumonectomy, leading to an orientation of the inferior vena cava flow toward the PFO. In terms of the aortic root dilation, an anatomical change of the atrial septum is described that is related to the pressure applied from the dilated aortic root down to the atrium, causing an aneurismal motion defect [10]. …”

Section: Discussionmentioning

confidence: 99%

Persistent hypoxemia and platypnea-orthodeoxia after left single-lung transplantation: a case report

2015

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IntroductionPlatypnea-orthodeoxia is a relatively uncommon but striking clinical syndrome characterized by dyspnea and deoxygenation accompanying a change to sitting or standing from a recumbent position. Hypoxemia early after lung transplant can have multiple etiologies. We report a rare case of persistent hypoxemia and platypnea-orthodeoxia after left single-lung transplantation, as a result of right-to-left interatrial shunt through a patent foramen ovale, with subsequent resolution of hypoxemia after percutaneous closure of the patent foramen ovale.Case presentationOur 66-year-old Caucasian male patient exhibited a persistent patent foramen ovale. Persistent patent foramen ovale produces an intermittent intra-atrial right-to-left shunt and occurs in approximately 25 % of the general population. Although the majority of people with patent foramen ovale are asymptomatic, it is believed to act as a pathway for chemicals or thrombi that can result in a variety of clinical manifestations, including stroke, migraine headache, decompression sickness, high-altitude pulmonary edema, and platypnea-orthodeoxia syndrome. Percutaneous closure of the patent foramen ovale has been shown to be effective in the case of right-to-left shunting with normal pulmonary arterial pressure, but the indication remains controversial in other situations where pulmonary pressures are not normal. The most common causes of hypoxemia immediately after lung transplant include: graft dysfunction, reperfusion injury, acute thromboembolic disease, and acute rejection. We report a case of reopening of a patent foramen ovale after left single-lung transplantation with normal pulmonary pressure.ConclusionsOur case demonstrates that an open patent foramen ovale leading to massive right-to-left shunting is a possible complication after lung transplant, with significant morbidity, and that it can be treated successfully using a percutaneously placed occlusion device. Through this case report, we aim to improve pre-transplant procedures by demonstrating that a bubble contrast transesophageal echocardiogram can be performed pre-operatively to detect a patent foramen ovale.

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Section: Discussionmentioning

confidence: 99%

Persistent hypoxemia and platypnea-orthodeoxia after left single-lung transplantation: a case report

2015

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“…6 The underlying mechanism could be akin to what has been described in the case of the platypnea-orthodeoxia syndrome observed after pneumonectomy 7-10 or in patients with an enlarged aortic root. [11][12][13] Platypnea-orthodeoxia syndrome, characterized by the association of dyspnea and hypoxemia aggravated by upright position and relieved in the supine position, is related to intracardiac or intrapulmonary right-to-left shunting of various causes. 14 In particular, it may appear after a pneumonectomy (most often a right pneumonectomy) after a variable delay.…”

Section: Discussionmentioning

confidence: 99%

Delayed reopening of a hemodynamically significant patent foramen ovale after left lung transplantation: Emergency management

Mal¹,

Biondi²,

Gaudry³

et al. 2010

The Journal of Heart and Lung Transplantation

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“…[1] Several anatomical factors that can alter the atrial anatomy and facilitate shunting through an interatrial defect have been related with this syndrome. [1,2] In many cases, this syndrome has been associated with patent foramen ovale [3] and right-to-left shunt. Rarely platypnea-orthodeoxia syndrome has been described associated with an aortic aneurysm too.…”

Section: Case Reportmentioning

confidence: 99%

Patent foramen ovale and ascending aortic aneurysm with platypnea-orthodeoxia syndrome

Patanè¹,

Patanè²,

Zingarelli³

et al. 2009

International Journal of Cardiology

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Right-to-left interatrial shunt despite normal pulmonary artery pressure. Anatomical implications

Cited by 9 publications

References 11 publications

Persistent hypoxemia and platypnea-orthodeoxia after left single-lung transplantation: a case report

Persistent hypoxemia and platypnea-orthodeoxia after left single-lung transplantation: a case report

Delayed reopening of a hemodynamically significant patent foramen ovale after left lung transplantation: Emergency management

Patent foramen ovale and ascending aortic aneurysm with platypnea-orthodeoxia syndrome

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