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Posture-dependent dyspnea and cyanosis after pneumonectomy
European Journal of Respiratory Diseases
|December 1, 1981
Summary
A previously undetected open foramen ovale caused a right-to-left shunt after pneumonectomy, worsening with changes in body position. Successful closure resolved the shunt, highlighting the importance of foramen ovale assessment post-pneumonectomy.
Area of Science:
- Cardiology
- Thoracic Surgery
- Pulmonary Medicine
Background:
- Pneumonectomy, a surgical removal of a lung, can lead to significant hemodynamic and respiratory changes.
- An open foramen ovale (PFO) is a congenital heart defect that can cause paradoxical embolism and shunting.
- The interplay between post-pneumonectomy physiological changes and pre-existing cardiac conditions like PFO is not fully understood.
Observation:
- A 61-year-old male presented with progressive signs of a right-to-left shunt two months after pneumonectomy.
- The shunt's severity was notably exacerbated in the sitting and left lateral recumbent positions.
- These symptoms were attributed to a previously asymptomatic open foramen ovale.
Findings:
- Hemodynamic and ventilation parameters were assessed in relation to body position before and after PFO closure.
- Successful closure of the open foramen ovale effectively resolved the right-to-left shunt.
- Positional changes significantly influenced shunt severity in the presence of an open foramen ovale post-pneumonectomy.
Implications:
- This case underscores the potential for previously asymptomatic open foramen ovale to manifest clinically after major thoracic surgery.
- Understanding the impact of body position on shunting is crucial for managing patients with PFO after pneumonectomy.
- Routine screening for cardiac shunts may be warranted in select patients undergoing pneumonectomy, especially those with risk factors for PFO.