Detection of Right to Left Shunt by Transesophageal Echocardiography in a Patient with Postoperative Hypoxemia

• Main Authors: Yu-Ling Yeh, Chen-Kun Liu, Wen-Kuei Chang, Kwok-Hon Chan, Jihn-Yih Li, Shen-Kou Tsai
• Format: Article
• Language: English
• Published: Elsevier 2006-01-01
• Series: Journal of the Formosan Medical Association
• Subjects: cardiac surgery; hypoxemia; intracardiac right to left shunt; transesophageal echocardiography
• Online Access: http://www.sciencedirect.com/science/article/pii/S092966460960139X

Intracardiac right to left shunt through a patent foramen ovale (PFO) may result in the development of hypoxemia after cardiac surgery. Cardiac tamponade and mechanical ventilation with high positive end-expiratory pressure are the most common factors responsible for enhancing intracardiac right to left shunt through a PFO. We report an 83-year-old woman with Stanford type A dissecting aneurysm who developed hypoxemia and paradoxical air embolism after reconstruction of ascending aorta and Bental's procedure. Transesophageal echocardiography (TEE) revealed right to left shunting via a PFO. Surgical closure of the PFO was done without delay. This case illustrates the role of TEE in prompt diagnosis of intracardiac right to left shunting through a PFO causing postoperative hypoxemia after cardiac surgery.