Refractory Hypoxemia After Laparoscopic Nissen Fundoplication.

Area of Science:

• Cardiology
• Thoracic Surgery
• Medical Diagnostics

Background:

• Postoperative hypoxemia is a frequent complication following surgical procedures.
• Laparoscopic Nissen fundoplication is a common anti-reflux surgery.
• Identifying the cause of hypoxemia is crucial for effective patient management.

Observation:

• A 72-year-old woman developed platypnea-orthodeoxia immediately after laparoscopic Nissen fundoplication.
• This condition, characterized by shortness of breath when upright, suggested an intracardiac shunt.
• Refractory hypoxemia in the postoperative period prompted further investigation.

Findings:

• Echocardiography revealed shunting across a patent foramen ovale (PFO) as the cause of platypnea-orthodeoxia.
• Percutaneous device closure of the PFO provided a successful treatment.
• The PFO was identified as the source of the right-to-left intracardiac shunt.

Implications:

• Intracardiac shunts, particularly PFO, should be considered in cases of unexplained postoperative hypoxemia.
• Echocardiography is a valuable diagnostic tool for identifying intracardiac abnormalities.
• Timely diagnosis and intervention, such as percutaneous closure, can effectively manage shunt-related hypoxemia.