title: Detection of right to left shunt by transesophageal echocardiography in a patient with postoperative hypoxemia.
abstract: Intracardiac right to left shunt through a patent foramen ovale (PFO) may result in the development of hypoxemia after cardiac surgery. Cardiac tamponade and mechanical ventilation with high positive endexpiratory pressure are the most common factors responsible for enhancing intracardiac right to left shunt through a PFO. We report an 83-year-old woman with Stanford type A dissecting aneurysm who developed hypoxemia and paradoxical air embolism after reconstruction of ascending aorta and Bental's procedure. Transesophageal echocardiography (TEE) revealed right to left shunting via a PFO. Surgical closure of the PFO was done without delay. This case illustrates the role of TEE in prompt diagnosis of intracardiac right to left shunting through a PFO causing postoperative hypoxemia after cardiac surgery.
authors.affiliation: Department of Anesthesiology, Taipei Veterans General Hospital, Taiwan.
authors.forename: Yu-Ling
authors.initials: YL
authors.lastname: Yeh
authors.forename: Chen-Kun
authors.initials: CK
authors.lastname: Liu
authors.forename: Wen-Kuei
authors.initials: WK
authors.lastname: Chang
authors.forename: Kwok-Hon
authors.initials: KH
authors.lastname: Chan
authors.forename: Jihn-Yih
authors.initials: JY
authors.lastname: Li
authors.forename: Shen-Kou
authors.initials: SK
authors.lastname: Tsai
mesh_terms: D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery; D017548:Echocardiography, Transesophageal; D004618:Embolism, Air / Q000209:etiology; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging*; D006801:Humans; D000860:Hypoxia / Q000209:etiology*; D011183:Postoperative Complications