title: Right hemidiaphragmatic elevation with a right-to-left interatrial shunt through a patent foramen ovale: a case report and literature review.
abstract: A right-to-left shunt (RLS) is an uncommon complication of a patent foramen ovale (PFO) that may cause hypoxemia from venous admixture and ischemic complications from paradoxic embolization. This report presents the third described patient whose RLS through a PFO and profound hypoxemia developed in association with right hemidiaphragm dysfunction (but without a pressure gradient driving the right-to-left flow). In addition to extending the available experience with this unusual clinical event, we report on the successful closure of the PFO by a catheter-deployed double-umbrella device, after the positioning of which the patient's oxygenation normalized.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, the Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: S
authors.initials: S
authors.lastname: Ghamande
authors.forename: R
authors.initials: R
authors.lastname: Ramsey
authors.forename: J F
authors.initials: JF
authors.lastname: Rhodes
authors.forename: J K
authors.initials: JK
authors.lastname: Stoller
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization; D003937:Diagnosis, Differential; D003964:Diaphragm / Q000503:physiopathology; D019320:Embolism, Paradoxical / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006325:Heart Atria / Q000601:surgery; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D006346:Heart Septum / Q000601:surgery; D006801:Humans; D000860:Hypoxia / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D019736:Prostheses and Implants; D001261:Pulmonary Atelectasis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D012133:Respiratory Paralysis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery