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(Chest. 2005;128:998-1002.)
© 2005 American College of Chest Physicians

A Mystery Featuring Right-to-Left Shunting Despite Normal Intracardiac Pressure*

Mario Zanchetta, MD; Gianluca Rigatelli, MD and Siew Yen Ho, MD

* From the Department of Cardiovascular Disease (Drs. Zanchetta and Rigatelli), Cittadella General Hospital, Padua, Italy; and the Department of Paediatrics (Dr. Ho), Imperial College School of Medicine, London, UK.

Correspondence to: Mario Zanchetta, MD, Dipartimento di Malattie Cardiovascolari, Ospedale Civile, Via Riva Ospedale, 35013, Cittadella, Padova, Italy; e-mail: emodinacit{at}ulss15.pd.it

The cause of right-to-left atrial shunting despite normal intracardiac pressures and normal or near-normal pulmonary function through a patent foramen ovale has still not been completely clarified. It is probably responsible for several linked diseases, such as paradoxical embolism, platypnea-orthodeoxia syndrome, migraine with aura, transient global amnesia, and decompression sickness in sport divers. Despite modern diagnostic methods, the underlying anatomophysiologic and pathogenic mechanisms of right-to-left atrial shunting without abnormal intracardiac pressures remain a matter of debate and controversy. Holistically speaking, a return to a direct study of embryology, gross anatomy, and physiology may help us elucidate the real mechanism of this paradoxical shunting.

Key Words: intracardiac shunts • paradoxical embolism • patent foramen ovale




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