Hypoxemia secondary to right-to-left interatrial shunt through a patent foramen ovale in a patient with an elevated right hemidiaphragm.
Though uncommon, right-to-left shunt through a patent foramen ovale with normal right-side pressure and with a normal interatrial pressure gradient has been reported. The speculated pathophysiology is attributed to directional blood flow streaming from the vena cava to the left atrium. Hypoxemia secondary to right-to-left shunt with normal pulmonary artery pressure has been extensively documented after right pneumonectomy. Five prior cases have documented hypoxemia secondary to a right-to-left shunt through a patent foramen ovale in the presence of an elevated right hemidiaphragm. This is the sixth documented case of right-to-left shunt through a patent foramen ovale in the presence of an elevated right hemidiaphragm with a similar presentation in which closure of the patent foramen ovale resulted in resolution of hypoxemia.
Perkins
Linda A
LA
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of South Carolina, Columbia, SC 29203, USA. lperkins@gw.mp.sc.edu
Costa
Steven M
SM
Boethel
Carl D
CD
Lawrence
Mark E
ME
D000368:Aged; D003326:Coronary Circulation; D003964:Diaphragm / Q000002:abnormalities; D004452:Echocardiography; D005260:Female; D054092:Foramen Ovale, Patent / Q000601:surgery*; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D000860:Hypoxia / Q000209:etiology*