title: Dyspnea following thoracostomy closure after right pneumonectomy: An uncommon echocardiographic diagnosis and therapeutic approach.
abstract: Dyspnea and hypoxemia are common postoperative problems after pneumonectomy. One of the rarer causes of respiratory distress after right pneumonectomy is the development of a significant right-to-left shunt across a patent foramen ovale (PFO), which can evolve at a variable interval of time after the operation. We report here our experience with a patient who underwent right pneumonectomy, followed by several complications, and who presented severe dyspnea 7 months later, after the closure of a right thoracostomy. This report outlines the management of this challenging clinical condition; transesophageal echocardiography (TOE) provided a clear diagnosis and guided an effective percutaneous treatment.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Matteo
authors.identifier: http://orcid.org/0000-0001-5171-9259
authors.initials: M
authors.lastname: Pernigo
authors.affiliation: Division of Thoracic Surgery, AOUI Verona, Verona, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Canneto
authors.affiliation: Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Betta
authors.affiliation: Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Gionata
authors.initials: G
authors.lastname: Molinari
authors.affiliation: Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Flavio
authors.initials: F
authors.lastname: Ribichini
authors.affiliation: Division of Pneumology, AOUI Verona, Verona, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Zannini
authors.affiliation: Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Vassanelli
authors.affiliation: Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
mesh_terms: D003937:Diagnosis, Differential; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D004452:Echocardiography / Q000379:methods*; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D035583:Rare Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D013907:Thoracostomy / Q000009:adverse effects*; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000009:adverse effects*
keywords: patent foramen ovale; percutaneous intervention; three-dimensional transesophageal echocardiography; transesophageal Echocardiography