title: Right-to-left interatrial shunt secondary to right hemidiaphragmatic paralysis: an unusual scenario for urgent percutaneous closure of patent foramen ovale.
abstract: A 66 year-old female presented with a refractory hypoxaemia in association with an isolated paralysis of the right hemidiaphragm. Transoesophageal echocardiography (TEE) with both colour Doppler and bubble test demonstrated a significant patent foramen ovale (PFO)-mediated right-to-left shunt (RTLS) without an increased interatrial pressure gradient. The PFO was urgently closed by deployment of an AMPLATZER(®) occluder device, resulting in complete recovery of the arterial oxygen saturation and patient's symptoms. As noted on TEE, the RTLS was due to redirection of blood flow from the inferior vena cava directly through the PFO secondary to distortion of the cardiac anatomy by right hemidiaphragmatic paralysis.
authors.affiliation: Cardiology Clinic, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Fabris
authors.affiliation: Cardiology Clinic, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Buja
authors.affiliation: Cardiology Clinic, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Cucchini
authors.affiliation: Cardiology Clinic, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy.
authors.forename: Gianpiero
authors.initials: G
authors.lastname: D'Amico
authors.affiliation: Respiratory Disease Clinic, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Cazzuffi
authors.affiliation: Respiratory Disease Clinic, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Balestro
authors.affiliation: Cardiology Clinic, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy. Electronic address: giuseppe.tarantini.1@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
mesh_terms: D000368:Aged; D003964:Diaphragm / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D017548:Echocardiography, Transesophageal; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D010243:Paralysis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery
keywords: Hemidiaphragmatic paralysis; Patent foramen ovale; Percutaneous closure; Refractory hypoxaemia; Right-to-left shunt