1/11. Hypoxia due to patent foramen ovale in the absence of pulmonary hypertension.In most patients with a patent foramen ovale, blood flows from the left atrium to the right atrium in the absence of pulmonary hypertension. Our report describes a patient with a patent foramen ovale in whom flow occurred from the right atrium to the left atrium in the absence of pulmonary hypertension. We discuss hemodynamic findings and present a brief review of the pertinent medical literature regarding this phenomenon. We also discuss the role of transesophageal echocardiography in the diagnosis of this condition and in the elucidation of the underlying mechanisms, and we suggest several mechanisms that may explain the occurrence of this phenomenon in our patient.- - - - - - - - - - ranking = 1keywords = ovale (Clic here for more details about this article) |
2/11. Nonsurgical closure of a patent foramen ovale in a patient with carcinoid heart disease and severe hypoxia from interatrial shunting.We report the percutaneous transcatheter closure of a patent foramen ovale using an Amplatzer septal occluder in a rare patient with carcinoid heart disease involving both the right and left heart who presented with severe hypoxemia secondary to intra-atrial shunting. We believe this is the first report of this technique being utilized in a patient with carcinoid heart disease and it may represent an alternative to surgical closure in these patients at high risk for surgical complications.- - - - - - - - - - ranking = 0.83333333333333keywords = ovale (Clic here for more details about this article) |
3/11. Acute right-to-left inter-atrial shunt; an important cause of profound hypoxia.Three patients presented to our intensive care unit over a 3-yr period with profound hypoxia resulting from acute right-to-left inter-atrial shunt (RLIAS). Patient 1 was a 67-yr-old male with an atrial septal defect who became hypoxic and developed the rare sign of platypnoea following elective repair of an abdominal aortic aneurysm (breathlessness made worse when upright and relieved by lying flat). Patient 2 was a 38-yr-old female who developed platypnoea and hypoxia secondary to a patent foramen ovale (PFO) and pericardial effusion. Patient 3 was a 46-yr-old male with a PFO who developed hypoxia without platypnoea because of multiple pulmonary emboli following right hemicolectomy. These case reports illustrate the need to consider RLIAS as a cause of hypoxia of sudden onset. Early use of bubble contrast echocardiography is indicated.- - - - - - - - - - ranking = 0.16666666666667keywords = ovale (Clic here for more details about this article) |
4/11. Mitral atresia with premature closure of foramen ovale. A rare hemodynamic cause for failure of Blalock-Taussig anastomosis to relieve inadequate pulmonary blood flow.The clinical, hemodynamic, and surgical findings encountered in the management of a hypoxic male infant with a rare and complex variety of cyanotic congenital heart disease associated with inadequate pulmonary blood flow are described. A poor clinical response to creation of a Blalock-Taussig anastomosis led to the discovery of mitral atresia complicated by premature closure of the foramen ovale and partially relieved by the presence of a levoatriocardinal vein. The subsequent creation of an atrial septal defect enhanced the function of the subclavian artery to pulmonary artery anastomosis and provided palliative relief of hypoxia. Some of the clinical and laboratory findings indicating the presence of additional lesions complicating the picture of a tetralogy of fallot and requiring additional surgical considerations are discussed. The experience indicates that hemodynamic as well as surgical causes may explain the failure of a systemic artery to pulmonary artery anastomosis to function adequately and should be sought.- - - - - - - - - - ranking = 0.83333333333333keywords = ovale (Clic here for more details about this article) |
5/11. Presentation of non-Hodgkin's lymphoma as acute hypoxia caused by right ventricular compression.IMPLICATIONS: A case is presented of a woman developing acute right ventricular outflow tract obstruction because of mediastinal non-Hodgkin's lymphoma. Systemic blood flow was possible through a patent foramen ovale.- - - - - - - - - - ranking = 0.16666666666667keywords = ovale (Clic here for more details about this article) |
6/11. Transient platypnea-orthodeoxia-like syndrome induced by propafenone overdose in a young woman with Ebstein's anomaly.In this report we describe the case of a 37-year-old white woman with Ebstein's anomaly, who developed a rare syndrome called platypnea-orthodeoxia, characterized by massive right-to-left interatrial shunting with transient profound hypoxia and cyanosis. This shunt of blood via a patent foramen ovale occurred in the presence of a normal pulmonary artery pressure, and was probably precipitated by a propafenone overdose. This drug caused biventricular dysfunction, due to its negative inotropic effect, and hypotension, due to its peripheral vasodilatory effect. These effects gave rise to an increase in the right atrial pressure and a decrease in the left one with a consequent stretching of the foramen ovale and the creation of massive right-to-left shunting. In our case this interatrial shunt was very accurately detected at bubble contrast echocardiography.- - - - - - - - - - ranking = 0.33333333333333keywords = ovale (Clic here for more details about this article) |
7/11. Sildenafil in management of persistent pulmonary hypertension of the newborn: report of two cases.Persistent pulmonary hypertension of the newborn (PPHN) was described in 1969 by Gersomy and co-workers as persistent foetal circulation. Supra - systemic pulmonary artery pressures result in right to left shunting of blood through the ductus arteriosus and/or foramen ovale. This results from failure of the normal adaptation to extra uterine life of the foetal heart/lung system. The incidence is estimated at about 0.1-0.2% of live born infants, majority being term or post term. There is no race or gender related predisposition. Management was always difficult before the advent of nitric oxide (and now sildenafil). We report two newborn infants born at The Mater Hospital with perinatal asphyxia resulting inpersistent pulmonary hypertension that were successfully managed with sildenafil.- - - - - - - - - - ranking = 0.16666666666667keywords = ovale (Clic here for more details about this article) |
8/11. Right-to-left shunting after lobectomy through a patent foramen ovale.Hypoxia and dyspnea after lung resection may be caused by a variety of factors. One entity that has been rarely described is right-to-left shunting across an interatrial communication in the absence of elevated right-sided pressures. We describe the occurrence of clinically evident right-to-left shunting after lobectomy in a patient with a patent foramen ovale and suggest that two-dimensional contrast echocardiography is a useful and minimally invasive means of diagnosing what may be a more common entity than was previously recognized.- - - - - - - - - - ranking = 0.83333333333333keywords = ovale (Clic here for more details about this article) |
9/11. Platypnea-orthodeoxia: clinical profile, diagnostic workup, management, and report of seven cases.Platypnea-orthodeoxia is a rare and poorly understood syndrome of orthostatic accentuation of a right-to-left shunt, usually across a patent foramen ovale. The syndrome is most commonly recognized in patients with a history of a major pulmonary disorder such as pneumonectomy, recurrent pulmonary emboli, or chronic lung disease. pulmonary artery pressures are typically normal. The physiologic mechanism is unknown. We recommend that initial assessment consist of measurement of blood gases with the patient in the supine and upright positions. Orthostatic desaturation should prompt further investigation. A definitive diagnosis can most easily be obtained by tilt-table two-dimensional echocardiography with peripheral venous contrast medium. The shunt can be localized at the atrial level and directly visualized and semiquantitated. The decision about surgical closure of the patent foramen ovale is based on the degree of clinical disability. Because a significant shunt is manifest only in the upright position, astute clinical suspicion is of paramount importance for proper diagnosis. Increased awareness of this syndrome and ease of echocardiographic diagnosis will facilitate recognition of this potentially treatable cause of orthostatic hypoxia.- - - - - - - - - - ranking = 0.33333333333333keywords = ovale (Clic here for more details about this article) |
10/11. Intermittent hypoxia due to right atrial compression by an ascending aortic aneurysm.Two cases are described wherein right atrial compression from a dilated and elongated ascending aorta caused intermittent positional hypoxia. Extrinsic compression of the right atrium caused shunting though a patent foramen ovale.- - - - - - - - - - ranking = 0.16666666666667keywords = ovale (Clic here for more details about this article) |
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