Intermittent hypoxaemia without orthodeoxia due to right-to-left shunting related to an elongated aorta.
An elderly woman presented with unexplained, intermittent hypoxaemia unrelated to posture. Subsequent investigations revealed intermittent and variable right-to-left interatrial shunting through a patent foramen ovale in the presence of normal pulmonary arterial and intracardiac pressures, caused by right atrial compression from a horizontal, elongated ascending aorta. Surgical closure of the foramen resulted in marked clinical improvement.
Tan
K L
KL
Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Robinson
T D
TD
Celermajer
D S
DS
Hughes
C F
CF
Young
I H
IH
D000368:Aged; D001018:Aortic Diseases / Q000150:complications*; D003326:Coronary Circulation; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications*; D006801:Humans; D000860:Hypoxia / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors