A patent foramen ovale (PFO) is a common structural cardiac variant occurring in approximately 30% of the general population. Patients are usually asymptomatic because the defect is flap-like and does not permit significant left-to-right shunting. However, pathological conditions that result in cardiac rotation or higher than normal right atrial pressures can reverse the normal left atrial to right atrial pressure gradient and cause a right-to-left shunt through a PFO. If the right-to-left shunt is persistent, systemic hypoxemia or paradoxical emboli may result. The present report describes a case of refractory hypoxemia in a critically ill patient with a PFO who had a right-to-left shunt with normal right-sided cardiac pressures. © 2008 Pulsus Group Inc. All rights reserved.
Gomperts, N., Fowler, R., Horlick, E., & McLaughlin, P. (2008). A broken heart: Right-to-left shunt in the setting of normal cardiac pressures. Canadian Journal of Cardiology. Pulsus Group Inc. https://doi.org/10.1016/S0828-282X(08)70591-9