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Case ReportCase Reports

Hypoxemia Secondary to Right-to-Left Interatrial Shunt Through a Patent Foramen Ovale in a Patient With an Elevated Right Hemidiaphragm

Linda A Perkins, Steven M Costa, Carl D Boethel and Mark E Lawrence
Respiratory Care April 2008, 53 (4) 462-465;
Linda A Perkins
Texas A&M University System Health Science Center, Temple, Texas
Division of Pulmonary and Critical Care, Department of Internal Medicine, University of South Carolina, Columbia, South Carolina
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  • For correspondence: [email protected]
Steven M Costa
Scott and White Memorial Hospital and Clinic, and Scott, Sherwood, and Brindley Foundation, and The Texas A&M University System Health Science Center College of Medicine, Temple, Texas
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Carl D Boethel
Scott and White Memorial Hospital and Clinic, and Scott, Sherwood, and Brindley Foundation, and The Texas A&M University System Health Science Center College of Medicine, Temple, Texas
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Mark E Lawrence
Scott and White Memorial Hospital and Clinic, and Scott, Sherwood, and Brindley Foundation, and The Texas A&M University System Health Science Center College of Medicine, Temple, Texas
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Abstract

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.

  • cardiac shunt
  • septal occlusion device
  • diaphragm paralysis
  • refractory hypoxemia
  • dyspnea
  • patent foramen ovale

Footnotes

  • Correspondence: Linda A Perkins MD, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of South Carolina, Eight Medical Park, Suite 410, Columbia SC 29203. E-mail: lperkins{at}gw.mp.sc.edu.
  • Copyright © 2008 by Daedalus Enterprises Inc.
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Respiratory Care: 53 (4)
Respiratory Care
Vol. 53, Issue 4
1 Apr 2008
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Hypoxemia Secondary to Right-to-Left Interatrial Shunt Through a Patent Foramen Ovale in a Patient With an Elevated Right Hemidiaphragm
Linda A Perkins, Steven M Costa, Carl D Boethel, Mark E Lawrence
Respiratory Care Apr 2008, 53 (4) 462-465;

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Hypoxemia Secondary to Right-to-Left Interatrial Shunt Through a Patent Foramen Ovale in a Patient With an Elevated Right Hemidiaphragm
Linda A Perkins, Steven M Costa, Carl D Boethel, Mark E Lawrence
Respiratory Care Apr 2008, 53 (4) 462-465;
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Keywords

  • cardiac shunt
  • septal occlusion device
  • diaphragm paralysis
  • refractory hypoxemia
  • dyspnea
  • patent foramen ovale

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