Journal of the Formosan Medical Association
Volume 105, Issue 5 , Pages 418-421, 2006

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

  • Yu-Ling Yeh

      Affiliations

    • Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
    • Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
    • ,
  • Chen-Kun Liu

      Affiliations

    • Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
    • ,
  • Wen-Kuei Chang

      Affiliations

    • Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
    • ,
  • Kwok-Hon Chan

      Affiliations

    • Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
    • ,
  • Jihn-Yih Li

      Affiliations

    • Buddhist Tzu Chi General Hospital, Taipei, Taiwan
    • ,
  • Shen-Kou Tsai

      Affiliations

    • Buddhist Tzu Chi General Hospital, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr. Shen-Kou Tsai, Buddhist Tzu Chi General Hospital Taipei Branch, 289 Jianguo Road, Xindian City, Taipei, Taiwan

Received 28 March 2005; received in revised form 24 May 2005; accepted 2 August 2005.

Article Outline

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.

Key Words:  cardiac surgery , hypoxemia , intracardiac right to left shunt , transesophageal echocardiography

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PII: S0929-6646(09)60139-X

doi:10.1016/S0929-6646(09)60139-X

Journal of the Formosan Medical Association
Volume 105, Issue 5 , Pages 418-421, 2006

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