Acute hypoxemia due to right-to-left shunt via a patent foramen ovale during left internal thoracic artery to left anterior descending artery anastomosis in off-pump coronary artery bypass grafting: a case report

Yuki Okutomi; Takeyuki Sajima; Atsushi Yasuda; Shigehito Sawamura

doi:10.1186/s40981-023-00607-x

Acute hypoxemia due to right-to-left shunt via a patent foramen ovale during left internal thoracic artery to left anterior descending artery anastomosis in off-pump coronary artery bypass grafting: a case report

Yuki Okutomi
, Takeyuki Sajima
, Atsushi Yasuda
, Shigehito Sawamura

School of Medicine

Teikyo University

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Background: A right-to-left shunt via a patent foramen ovale (PFO) during off-pump coronary artery bypass (OPCAB) may result in difficulties in oxygenation and circulatory management. We herein present a case of a marked shunt via a PFO during OPCAB. Case presentation: A 74-year-old man who had aortic root enlargement, compressing the right atrium, and an atrial septal aneurysm, underwent OPCAB. When the heart was fixed for the anastomosis of the left anterior descending artery, sudden hypoxemia and hypotension were observed. Intraoperative transesophageal echocardiography (TEE) showed a right-to-left shunt via a PFO that was unnoticed preoperatively. After the anastomosis was completed, TEE revealed no shunt through the PFO. Conclusions: We should check for a PFO in case of an atrial septal aneurysm. Compression of the right atrium is considered an important anatomical risk of the right-to-left shunt in OPCAB.

Original language	English
Article number	15
Journal	JA Clinical Reports
Volume	9
Issue number	1
DOIs	https://doi.org/10.1186/s40981-023-00607-x
State	Published - Dec 2023

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This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Aortic root enlargement
Atrial septal aneurysm
Hypoxemia
Off-pump coronary artery bypass grafting
Patent foramen ovale
Right-to-left shunt

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title = "Acute hypoxemia due to right-to-left shunt via a patent foramen ovale during left internal thoracic artery to left anterior descending artery anastomosis in off-pump coronary artery bypass grafting: a case report",

abstract = "Background: A right-to-left shunt via a patent foramen ovale (PFO) during off-pump coronary artery bypass (OPCAB) may result in difficulties in oxygenation and circulatory management. We herein present a case of a marked shunt via a PFO during OPCAB. Case presentation: A 74-year-old man who had aortic root enlargement, compressing the right atrium, and an atrial septal aneurysm, underwent OPCAB. When the heart was fixed for the anastomosis of the left anterior descending artery, sudden hypoxemia and hypotension were observed. Intraoperative transesophageal echocardiography (TEE) showed a right-to-left shunt via a PFO that was unnoticed preoperatively. After the anastomosis was completed, TEE revealed no shunt through the PFO. Conclusions: We should check for a PFO in case of an atrial septal aneurysm. Compression of the right atrium is considered an important anatomical risk of the right-to-left shunt in OPCAB.",

keywords = "Aortic root enlargement, Atrial septal aneurysm, Hypoxemia, Off-pump coronary artery bypass grafting, Patent foramen ovale, Right-to-left shunt",

author = "Yuki Okutomi and Takeyuki Sajima and Atsushi Yasuda and Shigehito Sawamura",

note = "Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = dec,

doi = "10.1186/s40981-023-00607-x",

language = "英語",

volume = "9",

journal = "JA Clinical Reports",

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number = "1",

}

Acute hypoxemia due to right-to-left shunt via a patent foramen ovale during left internal thoracic artery to left anterior descending artery anastomosis in off-pump coronary artery bypass grafting: a case report. / Okutomi, Yuki; Sajima, Takeyuki; Yasuda, Atsushi et al.
In: JA Clinical Reports, Vol. 9, No. 1, 15, 12.2023.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Acute hypoxemia due to right-to-left shunt via a patent foramen ovale during left internal thoracic artery to left anterior descending artery anastomosis in off-pump coronary artery bypass grafting

T2 - a case report

AU - Okutomi, Yuki

AU - Sajima, Takeyuki

AU - Yasuda, Atsushi

AU - Sawamura, Shigehito

PY - 2023/12

Y1 - 2023/12

N2 - Background: A right-to-left shunt via a patent foramen ovale (PFO) during off-pump coronary artery bypass (OPCAB) may result in difficulties in oxygenation and circulatory management. We herein present a case of a marked shunt via a PFO during OPCAB. Case presentation: A 74-year-old man who had aortic root enlargement, compressing the right atrium, and an atrial septal aneurysm, underwent OPCAB. When the heart was fixed for the anastomosis of the left anterior descending artery, sudden hypoxemia and hypotension were observed. Intraoperative transesophageal echocardiography (TEE) showed a right-to-left shunt via a PFO that was unnoticed preoperatively. After the anastomosis was completed, TEE revealed no shunt through the PFO. Conclusions: We should check for a PFO in case of an atrial septal aneurysm. Compression of the right atrium is considered an important anatomical risk of the right-to-left shunt in OPCAB.

AB - Background: A right-to-left shunt via a patent foramen ovale (PFO) during off-pump coronary artery bypass (OPCAB) may result in difficulties in oxygenation and circulatory management. We herein present a case of a marked shunt via a PFO during OPCAB. Case presentation: A 74-year-old man who had aortic root enlargement, compressing the right atrium, and an atrial septal aneurysm, underwent OPCAB. When the heart was fixed for the anastomosis of the left anterior descending artery, sudden hypoxemia and hypotension were observed. Intraoperative transesophageal echocardiography (TEE) showed a right-to-left shunt via a PFO that was unnoticed preoperatively. After the anastomosis was completed, TEE revealed no shunt through the PFO. Conclusions: We should check for a PFO in case of an atrial septal aneurysm. Compression of the right atrium is considered an important anatomical risk of the right-to-left shunt in OPCAB.

KW - Aortic root enlargement

KW - Atrial septal aneurysm

KW - Hypoxemia

KW - Off-pump coronary artery bypass grafting

KW - Patent foramen ovale

KW - Right-to-left shunt

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U2 - 10.1186/s40981-023-00607-x

DO - 10.1186/s40981-023-00607-x

M3 - 記事

AN - SCOPUS:85150732001

SN - 2363-9024

VL - 9

JO - JA Clinical Reports

JF - JA Clinical Reports

IS - 1

M1 - 15

ER -

Acute hypoxemia due to right-to-left shunt via a patent foramen ovale during left internal thoracic artery to left anterior descending artery anastomosis in off-pump coronary artery bypass grafting: a case report

Abstract

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Keywords

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