Chest
selected reportsAtrial Septal Aneurysm Plus a Patent Foramen Ovale: A Predisposing Factor for Paradoxical Embolism and Refractory Hypoxemia During Pulmonary Embolism
Section snippets
Case 1
A 74-year-old woman was admitted to the ICU in a deep coma and with severe hypoxemia requiring immediate mechanical ventilation. The chest x-ray film was normal. The ECG showed a sinus rhythm and a complete right bundle branch block. Measurements using a Swan-Ganz catheter confirmed right ventricular failure, inversion of the normal interatrial gradient (inferring the mean left atrial pressure from the mean pulmonary artery occlusive pressure), and important shunting (Table 1). Angiography
Discussion
We believe this to be the first transesophageal echocardiography study of pulmonary embolism complicated by the association of severe hypoxemia and paradoxical embolism. The fortuitous discovery of an atrial septal aneurysm plus a massive right-to-left shunt through a patent foramen ovale in patient 1 prompted the systematic check for these two anatomic abnormalities using transesophageal echocardiography with contrast10 in the next two patients who presented with similar symptoms (cases 2 and
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2008, Practice of Clinical Echocardiography, Thrid EditionIntractable intraoperative hypoxemia secondary to pulmonary embolism in the presence of undiagnosed patent foramen ovale
2007, Journal of Clinical AnesthesiaCitation Excerpt :The syndrome of pulmonary embolism (PE) can range from clinically unimportant to massive embolism leading to sudden death [6]. Pulmonary embolism in the presence of PFO or atrial septal defect can cause intracardiac right-to-left shunting of the blood, leading to severe hypoxemia and paradoxical embolism [7-9]. The management of a patient who developed severe hypoxemia caused by intraoperative PE in the presence of undiagnosed PFO during closed manipulation of a hip fracture is described.
Acute right-to-left inter-atrial shunt; an important cause of profound hypoxia
2000, British Journal of AnaesthesiaCitation Excerpt :A rise in right atrial pressure above left atrial pressure may precipitate RLIAS. This can be the result of obstruction of pulmonary blood flow by pulmonary embolus4 (Patient 3), increased transmural pressures in asthma,5 right ventricular hypokinesis following right ventricular infarction6 or coronary artery bypass grafting,7 or as a result of elevated Paco2 in hemidiaphragmatic paresis.8 However, in similar cases right heart pressures can be normal, which indicates that other factors can induce RLIAS.4 9 10
Respiratory support during pulmonary artery thromboembolia (Review)
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