Acute right-to-left inter-atrial shunt; an important cause of profound hypoxia

• Published in: British journal of anaesthesia : BJA Vol. 85; no. 6; pp. 921 - 925
• Main Authors: Marples, I.L., Heap, M.J., Suvarna, S.K., Mills, G.H.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.12.2000; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: Acute Disease; Adult; Aged; Biological and medical sciences; Cardiology. Vascular system; complications, hypoxia; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Critical Care - methods; Echocardiography, Transesophageal; Fatal Outcome; Female; Heart; Heart Septal Defects, Atrial - complications; Heart Septal Defects, Atrial - diagnostic imaging; heart, bubble contrast echocardiography; Humans; Hypoxia - etiology; intensive care; Male; Medical sciences; Middle Aged; intensive care; heart, bubble contrast echocardiography; complications, hypoxia; complications, hypoxia; heart, bubble contrast echocardiography; intensive care; Sonography; Human; Oxygen; Intensive care; Echocardiography; Persistent fetal circulation; Right to left shunt; Acute; Cardiovascular disease; Intracardiac defect; Congenital disease; Case study; Malformation; Heart disease; Atrial septal defect; Hypoxia; Diagnosis; Ostium secundum
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/85.6.921

Three patients presented to our intensive care unit over a 3-yr period with profound hypoxia resulting from acute right-to-left inter-atrial shunt (RLIAS). Patient 1 was a 67-yr-old male with an atrial septal defect who became hypoxic and developed the rare sign of platypnoea following elective repair of an abdominal aortic aneurysm (breathlessness made worse when upright and relieved by lying flat). Patient 2 was a 38-yr-old female who developed platypnoea and hypoxia secondary to a patent foramen ovale (PFO) and pericardial effusion. Patient 3 was a 46-yr-old male with a PFO who developed hypoxia without platypnoea because of multiple pulmonary emboli following right hemicolectomy. These case reports illustrate the need to consider RLIAS as a cause of hypoxia of sudden onset. Early use of bubble contrast echocardiography is indicated.