Source: Annual Congress 2001 - Disease of the pulmonary circulation
Disease area: Pulmonary vascular diseases

Abstract

Atrial right-to-left shunting (ARLS) with normal right-sided-pressures is an uncommon cause of acquired dyspnea in adults. The mechanism of this entity still remains not totally understood. We report seven cases of ARLS with a special view on associated circumstances. Five women and two men (age 64 to 73 years) complained of severe dyspnea with dramatic posture worsening and/or platypnea in 5 cases. Associated circumtances were : pneumonectomy (2 cases), elongation and dilatation of the proximal ascending aorta (6 cases), unilateral diaphragmatic paralysis (1 case). All had severe hypoxemia (mean PaO 56±]16 mmHg). ARLS was suspected because hypoxemia persisted during a 100% oxygen study and doppler-echocardiography showed a patent foramen ovale (PFO). In 5 cases, the ARLS was observed only when the contrast product was injected into the inferior vena cava. In these cases, we demonstrated that the ARLS was due to PFO, change in the right atria axis and preferential blood flow streaming from the inferior vena cava to the left atria. Among 2 patients ARLS was transient with a spontaneous recovery. Five patients underwent a closure of the PFO surgically in 3 cases and in 2 cases using a non invasive percutaneous procedure. Dramatic improvement was observed in all cases. We conclude that ARLS should be early recognized in patients with postural dyspnea, because percutaneous closure appears to be an afficient and safe treatment (Godart, Eur Heart J 2000;21:483-9)

Rating:

Share or cite this content

Citations should be made in the following way:
S. Pontier, G. Ferry, B. Degano, C. Hermant, M. Krempf, R. Escamilla (Toulouse, France). Acquired atrial right-to-left shunting with normal right-sided pressures: a seven case report. Eur Respir J 2001; 16: Suppl. 31, 3510

Member's Comments

No comment yet.

Related content which might interest you: Sinus venosus atrial septal defect in a 31-year-old female patient: a case for surgical repair Source: Eur Respir Rev 2010 19: 340-344 Year: 2010 Intracardiac shunt measurement by MRI in patients with pulmonary arterial hypertension caused by a congenital septum defect Source: Eur Respir J 2005; 26: Suppl. 49, 560s Year: 2005 Therapeutic approaches in adults with congenital heart disease-associated pulmonary arterial hypertension Source: Eur Respir Rev 2010 19: 300-307 Year: 2010 Dyspnoea and hypoxaemia after lung surgery: the role of interatrial right-to-left shunt Source: Eur Respir J 2006; 28: 174-181 Year: 2006 Embolisation of pulmonary arteriovenous malformations: no consistent effect on pulmonary artery pressure Source: Eur Respir J 2008; 32: 162-169 Year: 2008 Can pulmonary arterial CT obstruction index rate predict right ventricular dilatation in pulmonary embolism? Source: International Congress 2015 – Pulmonary circulation: the story of fresh and old clots Year: 2015 A large ostium secundum type atrial septal defect as a course for a syncope in a 78-year-old female Source: Eur Respir J 2001; 18: Suppl. 33, 522s Year: 2001 Prediction of right ventricular dysfunction in patients with pulmonary embolism Source: Eur Respir J 2007; 30: Suppl. 51, 602s Year: 2007 Right atrial enlargement and prognosis in the hemodinamically stable pulmonary embolism Source: Annual Congress 2012 - Pulmonary circulation: end-points and biomarkers Year: 2012 Prevalence and outcomes of pulmonary hypertension after percutaneous closure of atrial septal defect: a systematic review and meta-analysis Source: Eur Respir Rev, 29 (158) 200099; 10.1183/16000617.0099-2020 Year: 2020 Platypnea-orthodeoxia syndrome in a patient with an ascending aorta aneurysm and an persistent Eustachian valve : A case report Source: International Congress 2016 – Pulmonary hypertension in lung disease Year: 2016 Systemic aorto-pulmonary left to left fistula – rare cause of vascular compression of the airways Source: Eur Respir J 2006; 28: Suppl. 50, 497s Year: 2006 Recurrent pulmonary embolism due to right ventricular thrombus in a case of Behcet’s disease Source: Eur Respir J 2004; 24: Suppl. 48, 277s Year: 2004 Intracardiac thrombus and co-existing pulmonary artery aneurysm in behçet’s disease: two case reports Source: Eur Respir J 2004; 24: Suppl. 48, 278s Year: 2004 Right atrial pressure at rest and during exercise in patients with and without pulmonary hypertension: A retrospective analysis Source: International Congress 2018 – Pulmonary hypertension: right ventricle function, haemodynamics and exercise Year: 2018 Right-to-left shunt in pulmonary hypertension Source: Eur Respir J 2007; 30: Suppl. 51, 344s Year: 2007 The A-aDO2 rather than the Fick principle can be used to estimate the right-to-left shunt fraction in pulmonary arteriovenous malformation Source: Virtual Congress 2020 – New imaging techniques applied to old problems Year: 2020 Right ventricular stiffness impairs right atrial function in pulmonary arterial hypertension Source: Virtual Congress 2020 – Right ventricular function and pulmonary hypertension Year: 2020 Double-lung transplantation followed by delayed percutaneous repair for atrial septal defect-associated pulmonary arterial hypertension Source: Eur Respir J, 59 (1) 2102388; 10.1183/13993003.02388-2021 Year: 2022 Left ventricular systolic torsion is correlated to right ventricular dilation in pulmonary hypertension patients Source: International Congress 2015 – Pulmonary hypertension: the right ventricle and its load Year: 2015