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

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Abstract

Background

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).

Case

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.

Conclusions

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

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Authors and Affiliations

  1. Department of General Thoracic Surgery, Kyorin University School of Medicine, 6-20-2 shinkawa, Mitaka, Tokyo, 181-8611, Japan

    Nobuaki Arai, Yoko Nakazato, Keisei Tachibana, Yasushi Nagashima, Ryota Tanaka & Haruhiko Kondo

  2. Department of Respiratory Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi, Tokyo, 173-8610, Japan

    Riken Kawachi

  3. Department of Cardiovascular Surgery, Akashi Medical Center, 743-33 okubocho-yagi, Akashi, Hyogo, 674-0063, Japan

    Kazuma Okamoto

Authors
  1. Nobuaki Arai
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  2. Riken Kawachi
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  3. Yoko Nakazato
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  4. Keisei Tachibana
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  5. Yasushi Nagashima
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  6. Ryota Tanaka
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  7. Kazuma Okamoto
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  8. Haruhiko Kondo
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Correspondence to Riken Kawachi.

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Cite this article

Arai, N., Kawachi, R., Nakazato, Y. et al. A rare post-lobectomy complication of right-to-left shunt via foramen ovale. Gen Thorac Cardiovasc Surg 68, 1337–1340 (2020). https://doi.org/10.1007/s11748-019-01238-9

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  • DOI: https://doi.org/10.1007/s11748-019-01238-9

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