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Related Experiment Videos

Positional hyperventilation-induced hypoxaemia in pectus excavatum.

B Wallaert1, B Cavestri, C Fournier

  • 1Clinique des Maladies Respiratoires, Hôpital Albert Calmette, Boulevard du Pr. Jules Leclercq, 59037 Lille Cedex, France. bwallaert@chru-lille.fr

The European Respiratory Journal
|July 4, 2006
PubMed
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A young man with pectus excavatum experienced exercise intolerance due to a right-to-left shunt caused by a permeable foramen ovale. Surgical closure resolved his symptoms, highlighting a novel diagnostic approach for such shunts.

Area of Science:

  • Cardiology
  • Pulmonary Medicine
  • Medical Diagnostics

Background:

  • Pectus excavatum can cause exercise intolerance.
  • Normal resting pulmonary function tests may mask underlying cardiac shunts.
  • Identifying right-to-left shunts is crucial for managing unexplained exercise limitation.

Observation:

  • A 19-year-old male with pectus excavatum presented with severe exercise intolerance.
  • Clinical exercise testing revealed a significant alveolo-arterial oxygen gradient and hypoxemia, suggesting a right-to-left shunt.
  • Transesophageal echocardiography confirmed a patent foramen ovale with positional and inspiratory-dependent shunting.

Findings:

  • The right-to-left shunt was exacerbated by upright posture and deep inspiration.
  • Pharmacological stress (dobutamine) and supine hyperventilation did not induce shunting.

Related Experiment Videos

  • Closure of the patent foramen ovale using an atrial umbrella led to dramatic clinical and physiological improvement.

    • Implications:

    • This case demonstrates a specific hyperventilation maneuver in the upright position can unmask a patent foramen ovale in pectus excavatum patients.
    • Transcatheter closure of a patent foramen ovale is an effective treatment for exercise intolerance in selected patients.
    • Understanding positional shunting is vital for accurate diagnosis and management of cardiopulmonary exercise limitation.