Document Detail

Dyspnoea and hypoxaemia after lung surgery: the role of interatrial right-to-left shunt.
MedLine Citation:
PMID:  16816347     Owner:  NLM     Status:  MEDLINE    
After lung surgery, some patients complain of unexplained increased dyspnoea associated with hypoxaemia. This clinical presentation may be due to an interatrial right-to-left shunt despite normal right heart pressure. Some of these patients show postural dependency of hypoxaemia, whereas others do not. In this article, the pathogenesis and mechanisms involved in this post-surgical complication are discussed, and the techniques used for confirmation and localisation of shunt are reported. An invasive technique, such as right heart catheterisation with angiography, was often used in the past as the diagnostic procedure for the visualisation of interatrial shunt. As to noninvasive techniques, a perfusion lung scan may be used as the first approach as it may detect the effect of the right-to-left shunt by visualising an extrapulmonary distribution of the radioactive tracer. The 100% oxygen breathing test could also be used to quantify the amount of right-to-left shunt. Particular emphasis is given to newer imaging modalities, such as transoesophageal echocardiography, which is minimally invasive but highly sensitive in clearly visualising the atrial septum anatomy. Finally, the approach to closure of the foramen ovale or atrial septal defect is discussed. Open thoracotomy was the traditional approach in the past. Percutaneous closure has now become the most used and effective technique for the repair of the interatrial anatomical malformation.
C Marini; M Miniati; N Ambrosino; B Formichi; L Tonelli; G Di Ricco; C Michelassi; S Giusti; I Spadoni
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The European respiratory journal     Volume:  28     ISSN:  0903-1936     ISO Abbreviation:  Eur. Respir. J.     Publication Date:  2006 Jul 
Date Detail:
Created Date:  2006-07-03     Completed Date:  2007-01-17     Revised Date:  2013-05-23    
Medline Journal Info:
Nlm Unique ID:  8803460     Medline TA:  Eur Respir J     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  174-81     Citation Subset:  IM    
Pulmonary Unit, Clinical Physiology Institute, National Research Council, University of Pisa, Pisa, Italy.
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MeSH Terms
Anoxia / diagnosis*,  etiology
Dyspnea / diagnosis*,  etiology
Follow-Up Studies
Heart Defects, Congenital / pathology
Heart Septal Defects, Atrial / pathology
Lung / surgery*
Middle Aged
Postoperative Complications
Pulmonary Gas Exchange
Pulmonary Surgical Procedures / adverse effects*

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