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Atrial level right to left intracardiac shunt associated with postoperative hypoxemia: demonstration with contrast two-dimensional echocardiography
Authors:G C Rose  W F Armstrong  Y Mahomed  H Feigenbaum
Affiliation:From the Departments of Medicine and Surgery, Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana.
Abstract:
Transient hypoxemia is not uncommon after major cardiac or thoracic surgery. The differential diagnosis includes atelectasis, pulmonary embolus, pneumonitis, congestive heart failure and several other diverse cardiovascular and pulmonary problems. Less well recognized is transient right to left intracardiac shunting through a patient foramen ovale or previously unsuspected atrial septal defect. Three cases of clinically important hypoxemia associated with right to left shunting after aortocoronary bypass surgery are presented. The right to left shunting was documented with contrast-enhanced echocardiography, which is a simple, inexpensive and accurate means of screening patients for intracardiac right to left shunts and may play a valuable role in the postoperative management of patients.
Keywords:Address for reprints: Gregory C. Rose   MD   Indiana University School of Medicine   University Hospital N-562   926 West Michigan Street   Indianapolis   Indiana 46223.
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