Right-to-Left Atrial Shunt without Pulmonary Artery Hypertension

Abstract

A 70-year-old woman without any history of pulmonary or cardiac disease developed breathlessness with severe arterial hypoxemia. Cardiac ultrasound examination and spirometry were normal. Cardiac catheterization and intravenous microbubble injection demonstrated an interatrial right-to-left shunt. The defect was closed surgically, and the patient recovered immediately. On surgery, the aorta was elongated, inducing an angulation of the interatrial septum and leading to the atrial septal defect just above the inferior vena cava.

A case of atrial septal defect with repetitive hypoxic attacks during hemodialysis

“…The contrast echocardiography showed the bi-directional shunt flow between the atria. We interpreted that the hypoxic attack was due to functional right to left shunt [1][2][3] caused by the blood aspiration by the left ventricle, which got to negative by acute preload reduction during hemodialysis. We decided to perform the surgical correction of ASD, because hypoxia was known to indicate poor prognosis of unoperated patients with ASD [4].…”