Right-to-left interatrial shunt secondary to right hemidiaphragmatic paralysis: an unusual scenario for urgent percutaneous closure of patent foramen ovale

Tommaso Fabris; Paolo Buja; Umberto Cucchini; Gianpiero D'Amico; Riccardo Cazzuffi; Elisabetta Balestro; Giuseppe Tarantini

doi:10.1016/j.hlc.2014.11.003

Right-to-left interatrial shunt secondary to right hemidiaphragmatic paralysis: an unusual scenario for urgent percutaneous closure of patent foramen ovale

Heart Lung Circ. 2015 Apr;24(4):e56-9. doi: 10.1016/j.hlc.2014.11.003. Epub 2014 Nov 15.

Authors

Tommaso Fabris¹, Paolo Buja¹, Umberto Cucchini¹, Gianpiero D'Amico¹, Riccardo Cazzuffi², Elisabetta Balestro², Giuseppe Tarantini³

Affiliations

¹ Cardiology Clinic, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy.
² Respiratory Disease Clinic, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy.
³ Cardiology Clinic, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy. Electronic address: giuseppe.tarantini.1@gmail.com.

PMID: 25499594
DOI: 10.1016/j.hlc.2014.11.003

Abstract

A 66 year-old female presented with a refractory hypoxaemia in association with an isolated paralysis of the right hemidiaphragm. Transoesophageal echocardiography (TEE) with both colour Doppler and bubble test demonstrated a significant patent foramen ovale (PFO)-mediated right-to-left shunt (RTLS) without an increased interatrial pressure gradient. The PFO was urgently closed by deployment of an AMPLATZER(®) occluder device, resulting in complete recovery of the arterial oxygen saturation and patient's symptoms. As noted on TEE, the RTLS was due to redirection of blood flow from the inferior vena cava directly through the PFO secondary to distortion of the cardiac anatomy by right hemidiaphragmatic paralysis.

Keywords: Hemidiaphragmatic paralysis; Patent foramen ovale; Percutaneous closure; Refractory hypoxaemia; Right-to-left shunt.

Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Publication types

Case Reports

MeSH terms

Aged
Diaphragm* / diagnostic imaging
Diaphragm* / physiopathology
Diaphragm* / surgery
Echocardiography, Transesophageal
Female
Foramen Ovale, Patent* / complications
Foramen Ovale, Patent* / diagnostic imaging
Foramen Ovale, Patent* / physiopathology
Foramen Ovale, Patent* / surgery
Humans
Paralysis* / complications
Paralysis* / diagnostic imaging
Paralysis* / physiopathology
Paralysis* / surgery