title: Unusual cause of hypoxemia after automatic implantable cardioverter-defibrillatorleads extraction.
abstract: The indication of pacemaker/AICD removal are numerous. Serious complication can occur during their removal, severe tricuspid regurgitation is one of the complication. The occurrence of PFO is not uncommon among adult population. Shunting across PFO in most circumstance is negligible, but in some necessitates closure due to hypoxemia. We report a case of 62 year old man, while undergoing AICD removal, had an emergency sternotomy for cardiac tamponade. Postoperatively, he experienced profound hypoxemia refractory to oxygen therapy. Transthoracic Echocardiogram was performed to rule out intracardiac shunts at an early stage, but it was difficult to obtain an good imaging windows poststernotomy. A small pulmonary emboli was noted on CTPA, but was not sufficient to account for the level of hypoxemia and did not resolve with anticoagulation. Transesophageal echocardiogram showed flail septal tricuspid valve with severe TR and bidirectional shunt through large PFO. Patient was posted for surgery, tricuspid valve was replaced and PFO surgically closed. Subsequently, patient recovered well ad was discharged to home. Cause of hypoxemia might be due to respiratory or cardiac dysfunction. But for hypoxemia refractory to oxygen therapy, transoesophageal echocardiogram should be always considered and performed early as an diagnostic tool in post cardiac surgical patients.
authors.affiliation: Department of Cardiothoracic Anesthesia, Freeman Hospital, High Heaton, Newcatle upon Tyne, NE7 7DN, United Kingdom.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Raju
authors.forename: Chandrika
authors.initials: C
authors.lastname: Roysam
authors.forename: Rajendra
authors.initials: R
authors.lastname: Singh
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Clark
authors.forename: Christopher
authors.initials: C
authors.lastname: Plummer
mesh_terms: D017147:Defibrillators, Implantable; D020878:Device Removal; D017548:Echocardiography, Transesophageal; D006801:Humans; D000860:Hypoxia / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000601:surgery; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery