CASE REPORTS
JOURNAL ARTICLE
Add like
Add dislike
Add to saved papers

Persistent hypoxemia and platypnea-orthodeoxia after left single-lung transplantation: a case report.

INTRODUCTION: Platypnea-orthodeoxia is a relatively uncommon but striking clinical syndrome characterized by dyspnea and deoxygenation accompanying a change to sitting or standing from a recumbent position. Hypoxemia early after lung transplant can have multiple etiologies. We report a rare case of persistent hypoxemia and platypnea-orthodeoxia after left single-lung transplantation, as a result of right-to-left interatrial shunt through a patent foramen ovale, with subsequent resolution of hypoxemia after percutaneous closure of the patent foramen ovale.

CASE PRESENTATION: Our 66-year-old Caucasian male patient exhibited a persistent patent foramen ovale. Persistent patent foramen ovale produces an intermittent intra-atrial right-to-left shunt and occurs in approximately 25 % of the general population. Although the majority of people with patent foramen ovale are asymptomatic, it is believed to act as a pathway for chemicals or thrombi that can result in a variety of clinical manifestations, including stroke, migraine headache, decompression sickness, high-altitude pulmonary edema, and platypnea-orthodeoxia syndrome. Percutaneous closure of the patent foramen ovale has been shown to be effective in the case of right-to-left shunting with normal pulmonary arterial pressure, but the indication remains controversial in other situations where pulmonary pressures are not normal. The most common causes of hypoxemia immediately after lung transplant include: graft dysfunction, reperfusion injury, acute thromboembolic disease, and acute rejection. We report a case of reopening of a patent foramen ovale after left single-lung transplantation with normal pulmonary pressure.

CONCLUSIONS: Our case demonstrates that an open patent foramen ovale leading to massive right-to-left shunting is a possible complication after lung transplant, with significant morbidity, and that it can be treated successfully using a percutaneously placed occlusion device. Through this case report, we aim to improve pre-transplant procedures by demonstrating that a bubble contrast transesophageal echocardiogram can be performed pre-operatively to detect a patent foramen ovale.

Full text links

We have located links that may give you full text access.
Can't access the paper?
Try logging in through your university/institutional subscription. For a smoother one-click institutional access experience, please use our mobile app.

For the best experience, use the Read mobile app

Mobile app image

Get seemless 1-tap access through your institution/university

For the best experience, use the Read mobile app

All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

By using this service, you agree to our terms of use and privacy policy.

Your Privacy Choices Toggle icon

You can now claim free CME credits for this literature searchClaim now

Get seemless 1-tap access through your institution/university

For the best experience, use the Read mobile app