RT Journal Article
SR Electronic
T1 Dyspnoea and hypoxaemia after lung surgery: the role of interatrial right-to-left shunt
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 174
OP 181
DO 10.1183/09031936.06.00006405
VO 28
IS 1
A1 C. Marini
A1 M. Miniati
A1 N. Ambrosino
A1 B. Formichi
A1 L. Tonelli
A1 G. Di Ricco
A1 C. Michelassi
A1 S. Giusti
A1 I. Spadoni
YR 2006
UL http://erj.ersjournals.com/content/28/1/174.abstract
AB 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 approch 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.