title: Atrial right-to-left shunting causing severe hypoxaemia despite normal right-sided pressures. Report of 11 consecutive cases corrected by percutaneous closure.
abstract: BACKGROUND
  Hypoxaemia resulting from a right-to-left shunt occurs in patients with atrial septal defects and high pulmonary vascular resistance, but it is uncommon without pulmonary hypertension.
  
  
  METHODS
  We report on 11 consecutive patients (age: 59-78 years) in whom a patent foramen ovale or a small atrial septal defect with normal right-sided pressures led to significant cyanosis with clinical symptoms. Six of them had associated platypnoea and orthodeoxia. The diagnosis was confirmed by contrast transoesophageal echocardiography showing an atrial right-to-left shunt.
  
  
  RESULTS
  All but one were successfully treated by percutaneous closure of the inter-atrial defect. In one patient, delivery of the occluder failed due to kinking of the introducing sheath. Four complications were observed following the procedure: two supraventricular arrhythmias and a cerebrovascular accident, all resolved without sequelae; one patient died from a septic shock unrelated to the procedure. During follow-up (up to 30 months), no patient experienced any episode of desaturation due to inter-atrial shunting.
  
  
  CONCLUSIONS
  Cyanosis without pulmonary arterial hypertension in the adult should prompt the performance of contrast transoesophageal echocardiography to identify a possible atrial right-to-left shunt. Percutaneous closure of the defect allows efficient and rapid correction of the hypoxaemia and avoids the need for surgical closure.
authors.affiliation: Hôpital Cardiologique, Centre Hospitalier Régional et Universitaire, Lille, France.
authors.forename: F
authors.initials: F
authors.lastname: Godart
authors.forename: C
authors.initials: C
authors.lastname: Rey
authors.forename: A
authors.initials: A
authors.lastname: Prat
authors.forename: A
authors.initials: A
authors.lastname: Vincentelli
authors.forename: A
authors.initials: A
authors.lastname: Chmaït
authors.forename: C
authors.initials: C
authors.lastname: Francart
authors.forename: H
authors.initials: H
authors.lastname: Porte
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D017023:Coronary Angiography; D017548:Echocardiography, Transesophageal; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D000860:Hypoxia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome