AI Article Synopsis
- A 66-year-old man undergoing off-pump coronary artery bypass (OPCAB) had a patent foramen ovale (PFO) that caused interatrial shunting and acute hypoxemia influenced by heart position changes during surgery.
- The patient's right-to-left shunt flow was detected preoperatively and exacerbated during surgery, improving only after increasing oxygen levels.
- The case highlights the need for careful intraoperative monitoring and postoperative airway pressure management to handle shunt flow and prevent hypoxemia related to PFO.
Article Abstract
Background: Interatrial right-to-left shunt flow through a patent foramen ovale (PFO) can be caused by changes in heart position for anastomosis during off-pump coronary artery bypass (OPCAB). We herein present a case in which the direction of PFO shunt flow changed with heart position during OPCAB and the ventilation settings after sternal closure.
Case Presentation: A 66-year-old man with interstitial pneumonia underwent OPCAB. Preoperative transesophageal echocardiography revealed right-to-left shunt flow through a PFO induced by the Valsalva maneuver. During OPCAB, heart displacement resulted in right-to-left shunting and acute hypoxemia, which quickly improved with increase of inspired oxygen fraction. After chest closure, bidirectional shunt flow developed under increased airway pressure.
Conclusions: Vigilant intraoperative monitoring with TEE and postoperative airway pressure management are important to address shunt flow and hypoxemia due to PFO.
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Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11480267 | PMC |
| http://dx.doi.org/10.1186/s40981-024-00748-7 | DOI Listing |
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