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Related Experiment Videos

Right-to-left interatrial shunt after pneumonectomy

N C Bakris1, A J Siddiqi, C D Fraser

  • 1Department of Internal Medicine, Cleveland Clinic Foundation, Ohio 44195, USA.

The Annals of Thoracic Surgery
|January 1, 1997
PubMed
Summary

Platypnea and orthodeoxia (shortness of breath and low oxygen) can occur after pneumonectomy due to a right-to-left shunt through a patent foramen ovale. Surgical closure of this shunt significantly improves symptoms.

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Area of Science:

  • Cardiology
  • Pulmonology
  • Surgical Innovation

Background:

  • Platypnea and orthodeoxia are symptoms historically linked to congenital heart disease and severe lung conditions.
  • These symptoms manifest as shortness of breath and decreased oxygen saturation, particularly when upright.

Observation:

  • This study reports on four patients who developed platypnea and orthodeoxia following pneumonectomy.
  • Patients experienced significant drops in oxygen saturation and shortness of breath in the upright position, despite oxygen therapy.

Findings:

  • Cardiac catheterization revealed normal right atrial pressure, but diagnostic imaging confirmed a right-to-left interatrial shunt via a patent foramen ovale.
  • Surgical closure of the patent foramen ovale led to a marked improvement in oxygen saturation and resolution of shortness of breath in all patients.

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Implications:

  • Post-pneumonectomy patients with shortness of breath should be evaluated for platypnea and orthodeoxia.
  • A patent foramen ovale shunt can develop after pneumonectomy, even without elevated right heart pressures, and is exacerbated by the upright posture.
  • Surgical correction of the patent foramen ovale offers a highly effective treatment for these debilitating symptoms.