Critical care medicine · 2001
Pharmacologic exposure of an occult atrial septal defect.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Mackenzie I M, Banning A, Dyar O
Аннотация
OBJECTIVE: To describe the diagnostic technique used to identify the presence of a symptomatic interatrial shunt obscured by normal intracardiac pressures and to discuss the unusual findings in this case and their relevance to the investigation of patients with unexplained hypoxemia.
DESIGN: Case report.
SETTING: Intensive care unit of a university teaching hospital.
PATIENT: A patient with a variant of the platypnea-orthodeoxia syndrome.
INTERVENTIONS: Intravenous administration of metaraminol.
MEASUREMENTS AND MAIN RESULTS: Clinical examination and routine investigations ruled out pneumonia or myocardial infarction as a cause of respiratory failure, and pulmonary angiography was normal other than for the demonstration of an interatrial communication. Repeated transthoracic echocardiograms failed to indicate the presence of a significant interatrial shunt that was eventually detected following temporary shunt reversal with intravenous metaraminol and confirmation by bubble-contrast transesophageal echocardiography and right heart catheter studies.
CONCLUSIONS: Symptomatic right-to-left intracardiac shunt may occur in patients with normal intracardiac and pulmonary artery pressures. The presence of a significant shunt cannot be ruled out by transthoracic echocardiography without the use of bubble contrast.
DESIGN: Case report.
SETTING: Intensive care unit of a university teaching hospital.
PATIENT: A patient with a variant of the platypnea-orthodeoxia syndrome.
INTERVENTIONS: Intravenous administration of metaraminol.
MEASUREMENTS AND MAIN RESULTS: Clinical examination and routine investigations ruled out pneumonia or myocardial infarction as a cause of respiratory failure, and pulmonary angiography was normal other than for the demonstration of an interatrial communication. Repeated transthoracic echocardiograms failed to indicate the presence of a significant interatrial shunt that was eventually detected following temporary shunt reversal with intravenous metaraminol and confirmation by bubble-contrast transesophageal echocardiography and right heart catheter studies.
CONCLUSIONS: Symptomatic right-to-left intracardiac shunt may occur in patients with normal intracardiac and pulmonary artery pressures. The presence of a significant shunt cannot be ruled out by transthoracic echocardiography without the use of bubble contrast.