Intracardiac Right-to-Left Shunt Complicating Right Ventricular Failure

Sharif, Hasanat; Pezzella, A. Thomas; Farah, Husam H.; Baljepally, Raj

doi:10.1177/021849239900700408

Cited by 5 publications

(3 citation statements)

References 21 publications

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“…Systemically administered vasodilator or inotropic therapy has limited efficacy in decreasing shunt flow, as agents that decrease RA pressure simultaneously reduce the left atrial pressure, leaving the transatrial pressure gradient unchanged. Attempts to mechanically close a patent foramen ovale to decrease interatrial shunting in RVMI patients have had variable success (33,34). In our study, we observed that 3 of 13 RVMI patients had significant right-to-left shunting through a patent foramen ovale despite breathing at F i O 2 ϭ 1.0, whereas breathing NO consistently reduced the shunt flow and improved systemic oxygenation.…”

Section: Discussionmentioning

confidence: 51%

Hemodynamic effects of inhaled nitric oxide in right ventricular myocardial infarction and cardiogenic shock

Inglessis

Shin

Lepore

et al. 2004

Journal of the American College of Cardiology

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Section: Discussionmentioning

confidence: 51%

Hemodynamic effects of inhaled nitric oxide in right ventricular myocardial infarction and cardiogenic shock

Inglessis

Shin

Lepore

et al. 2004

Journal of the American College of Cardiology

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“…After our extensive literature search, we came across only one case of RVI complicated by VSD. According to Sharif et al RVIs have been reported to be associated with right-to-left shunt usually located at the atrial level ( 6 ). The novelty of our case lies in the development of left-to-right shunt at the level of muscular portion of interventricular septum.…”

Section: Discussionmentioning

confidence: 99%

Ventricular septal defect: early against late surgical repair

Siddiqui

Iyer

Amba

et al. 2016

Journal of Community Hospital Internal Medicine Perspectives

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Ventricular septal defect (VSD) is a rare complication of right ventricular infarction (RVI) which is associated with significant mortality, if not treated appropriately. It typically occurs within the first 10–14 days after myocardial infarction. Surgical repair has been shown to reduce in-hospital mortality from 90% to 33–45%. Early surgical VSD repair has also been associated with high 30-day operative mortality of 34–37%. Furthermore, after an acute MI the friable myocardium enhances the risk of recurrent VSD with early surgical repair. We present a case of a middle-aged woman who developed VSD after an RVI. Her surgical repair was delayed by 2 weeks due to development of Staphylococcus aureus bacteremia. During this period, she was managed medically and later on underwent percutaneous repair with an amplatzer VSD occluder device. Keeping this patient encounter in mind, we would like to emphasize on the limited recommendations available for early against late surgical repair of VSD.

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“…Sharif et al 15 published a literature review in 1999 describing 15 such cases, including 3 of their own, and there have been two case reports since that time 17 18. Overall, of all these reported cases, eight underwent PFO closure and nine were managed conservatively 15 17 18…”

Section: Discussionmentioning

confidence: 99%

Transient right-to-left intracardiac shunt following a right ventricular myocardial infarction

2013

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SUMMARYA 56-year-old smoker presented with a 3-day history of intermittent chest pain. Cardiovascular examination on admission was normal. ECG showed minimal (<1 mm) ST elevation in lead III, and right-sided leads revealed similar mild ST-elevation. Troponin I was elevated at 10.91. He was managed as a delayed-presentation ST-elevation myocardial infarction case. 12 h following admission, he developed oxygen-resistant hypoxia and hypotension. There were no clinical or radiological signs of pulmonary congestion. CT pulmonary angiogram revealed no pulmonary embolus. A bubble-contrast echocardiogram confirmed an active interatrial right-to-left shunt without Valsalva provocation. His hypoxia steadily improved over the following 24 h and he did not require any shunt closure. A repeat bubble contrast echocardiogram showed that the shunt was now only active following a Valsalva manoeuvre. Transoesophageal echocardiography confirmed a patent foramen ovale. This is a rare but important cause of resistant hypoxia following a right-heart infarct. BACKGROUND

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Intracardiac Right-to-Left Shunt Complicating Right Ventricular Failure

Cited by 5 publications

References 21 publications

Hemodynamic effects of inhaled nitric oxide in right ventricular myocardial infarction and cardiogenic shock

Hemodynamic effects of inhaled nitric oxide in right ventricular myocardial infarction and cardiogenic shock

Ventricular septal defect: early against late surgical repair

Transient right-to-left intracardiac shunt following a right ventricular myocardial infarction

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