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(Chest. 2001;120:2094-2096.)
© 2001 American College of Chest Physicians

Right Hemidiaphragmatic Elevation With a Right-to-Left Interatrial Shunt Through a Patent Foramen Ovale*

A Case Report and Literature Review

Shekhar Ghamande, MD; Rory Ramsey, MD; John F. Rhodes, MD and James K. Stoller, MS, MD, FCCP

* From the Departments of Pulmonary and Critical Care Medicine (Drs. Ghamande and Stoller) and Pediatric Cardiology (Dr. Rhodes), the Division of Medicine (Dr. Ramsey), the Cleveland Clinic Foundation, Cleveland, OH.

Correspondence to: James K. Stoller, MD, FCCP, Department of Pulmonary and Critical Care Medicine, A90, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195; e-mail: stollej{at}ccf.org

A right-to-left shunt (RLS) is an uncommon complication of a patent foramen ovale (PFO) that may cause hypoxemia from venous admixture and ischemic complications from paradoxic embolization. This report presents the third described patient whose RLS through a PFO and profound hypoxemia developed in association with right hemidiaphragm dysfunction (but without a pressure gradient driving the right-to-left flow). In addition to extending the available experience with this unusual clinical event, we report on the successful closure of the PFO by a catheter-deployed double-umbrella device, after the positioning of which the patient’s oxygenation normalized.

Key Words: diaphragm dysfunction • hypoxemia • patent foramen ovale






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