Dyspnea and hypoxemia are common postoperative problems following pneumonectomy. Platypnea,
the increased dyspnea in the erect position relieved by assuming a prone position,
has been reported as a result of right to left inter-atrial shunt. We report here
on our experience with a patient who had severe platypnea with remarkable positional
arterial desaturation following right pneumonectomy. After establishing the diagnosis
with contrast-enhanced transesophageal echocardiography of the preoperatively undetected
interatrial right-left shunt, cardiac surgery led to clinical improvement and resumption
of platypnea. Given the rarity of the diagnosis, we think interatrial shunt, based
on an open foramen ovale, should be taken into consideration when platypnea occurs
in patients as a postoperative complication following lung surgery. Transesophageal
echocardiography may be helpful in detecting patients with “anatomical closed but
functional open” foramen ovale or genuine inter-atrial septal defect prior to lung
surgery.
Key words:
Pneumonectomy - - Platypnea - - Inter-atrial shunt - - Foramen ovale
References
Received for Publication: January 6, 2000
julianmall@hotmail.com
