Une dyspnée exceptionnelle en médecine interne: la platypnée-orthodéoxie après pneumonectomie

Danner, I.; Germaud, P.; Clarke, J P; Ordronneau, J; Boutoille, David; Habash, Ousama Al; Barrier, J

doi:10.1016/s0248-8663(97)83699-5

Cited by 5 publications

(1 citation statement)

References 9 publications

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“…In order to confirm the diagnosis of interatrial right-to-left shunt, right heart angiography was the technique more frequently used until 1988 [28]. Nowadays, it has been progressively replaced by contrast transthoracic or transoesophageal echocardiography, performed in 29 (63%) patients in the present series.…”

Section: Diagnostic and Therapeutic Managementmentioning

confidence: 85%

Dyspnoea and hypoxaemia after lung surgery: the role of interatrial right-to-left shunt

Marini¹

2006

Eur Respir J

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After lung surgery, some patients complain of unexplained increased dyspnoea associated with hypoxaemia. This clinical presentation may be due to an interatrial right-to-left shunt despite normal right heart pressure. Some of these patients show postural dependency of hypoxaemia, whereas others do not.In this article, the pathogenesis and mechanisms involved in this post-surgical complication are discussed, and the techniques used for confirmation and localisation of shunt are reported.An invasive technique, such as right heart catheterisation with angiography, was often used in the past as the diagnostic procedure for the visualisation of interatrial shunt. As to noninvasive techniques, a perfusion lung scan may be used as the first approach as it may detect the effect of the right-to-left shunt by visualising an extrapulmonary distribution of the radioactive tracer. The 100% oxygen breathing test could also be used to quantify the amount of right-to-left shunt. Particular emphasis is given to newer imaging modalities, such as transoesophageal echocardiography, which is minimally invasive but highly sensitive in clearly visualising the atrial septum anatomy.Finally, the approch to closure of the foramen ovale or atrial septal defect is discussed. Open thoracotomy was the traditional approach in the past. Percutaneous closure has now become the most used and effective technique for the repair of the interatrial anatomical malformation.

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Section: Diagnostic and Therapeutic Managementmentioning

confidence: 85%