A broken heart: right-to-left shunt in the setting of normal cardiac pressures.
A patent foramen ovale (PFO) is a common structural cardiac variant occurring in approximately 30% of the general population. Patients are usually asymptomatic because the defect is flap-like and does not permit significant left-to-right shunting. However, pathological conditions that result in cardiac rotation or higher than normal right atrial pressures can reverse the normal left atrial to right atrial pressure gradient and cause a right-to-left shunt through a PFO. If the right-to-left shunt is persistent, systemic hypoxemia or paradoxical emboli may result. The present report describes a case of refractory hypoxemia in a critically ill patient with a PFO who had a right-to-left shunt with normal right-sided cardiac pressures.
Gomperts
Natalie
N
Division of Cardiology, Faculty of Medicine, University of Western Ontario, London Health Sciences Centre University Hospital.
Fowler
Robert
R
Horlick
Eric
E
McLaughlin
Peter
P
D004452:Echocardiography; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D000860:Hypoxia / Q000209:etiology*; D008875:Middle Aged; D017725:Ventricular Pressure