A rare post-lobectomy complication of right-to-left shunt via foramen ovale

  • Nobuaki Arai
  • Riken KawachiEmail author
  • Yoko Nakazato
  • Keisei Tachibana
  • Yasushi Nagashima
  • Ryota Tanaka
  • Kazuma Okamoto
  • Haruhiko Kondo
Case Report



Various complications can cause hypoxemia after pulmonary resection for lung cancer, but intracardiac shunt that becomes symptomatic and causes severe hypoxemia postoperatively is very rare. We report a case that presented platypnea-orthodeoxia syndrome (POS) due to right-to-left shunt via patent foramen ovale (PFO).


A 71-year-old man with a lung cancer in the left upper lobe was referred to our hospital. Left upper lobectomy was performed. Dyspnea developed postoperatively, which was worsened by sitting or standing and relieved in a recumbent position. Contrast transesophageal echocardiogram (TEE) and right intracardiac catheterization revealed a right-to-left shunt via PFO. Open-heart closure of PFO was performed and the patient was free from POS.


Postoperative intracardiac shunt via PFO can cause severe hypoxemia after lung resection. POS suggests the possibility of intracardiac shunt and careful observation is needed.


Platypnea-orthodeoxia syndrome Lung cancer Complication Intracardiac shunt Patent foramen ovale 


Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest associated with this manuscript.


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Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

  1. 1.Department of General Thoracic SurgeryKyorin University School of MedicineMitaka, TokyoJapan
  2. 2.Department of Respiratory SurgeryNihon University School of MedicineTokyoJapan
  3. 3.Department of Cardiovascular SurgeryAkashi Medical CenterAkashiJapan

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