Document Detail

Transesophageal echocardiographic and oxymetric evidence of intraoperative reversal of flow through a patent foramen ovale during an off-pump coronary artery bypass grafting.
MedLine Citation:
PMID:  16427533     Owner:  NLM     Status:  MEDLINE    
Mechanical stabilization of target coronary arteries in the beating heart has facilitated the practice of "off-pump" coronary artery bypass grafting. Exposing the target coronary artery for stabilization involves maneuvers that frequently cause hemodynamic alterations including decreased cardiac output and increased pulmonary artery and/or central venous pressures (CVP). The presence of a patent foramen ovale (PFO) in the setting of increased CVP may produce a right-to-left shunt through the PFO. We report a case of a patient undergoing off-pump coronary artery bypass grafting with a PFO with a left to right atrium shunt flow of 307 mL/min. During manipulation and elevation of the heart to expose the target vessel, the CVP increased from 15 to 30 mm Hg and the shunt through the PFO reversed direction, going from right to left atrium with a flow of 161 mL/min. Mixed venous oxygen saturation and the calculated shunt fraction decreased from 84% to 78% and 14% to 10%, respectively. All parameters returned to normal after the heart was lowered back inside the chest.
Octavio A Falcucci; Vigneshwar Kasirajan; Jeffrey A Green
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of clinical anesthesia     Volume:  17     ISSN:  0952-8180     ISO Abbreviation:  J Clin Anesth     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2006-01-23     Completed Date:  2006-04-27     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8812166     Medline TA:  J Clin Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  617-20     Citation Subset:  IM    
Department of Anesthesiology, Virginia Commonwealth University, Box 980695, Richmond, VA 23298, USA.
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MeSH Terms
Central Venous Pressure / physiology
Coronary Artery Bypass, Off-Pump / methods*
Echocardiography, Doppler / methods
Echocardiography, Transesophageal / methods*
Heart Septal Defects, Atrial / physiopathology*,  surgery*
Hemodynamics / physiology
Monitoring, Intraoperative / methods*
Oximetry / methods*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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