Dynamic shunt flow alterations through patent foramen ovale during off-pump coronary artery bypass grafting induced by airway pressure changes: a case report.

Pub Date : 2024-10-15 DOI:10.1186/s40981-024-00748-7

Ayano Honda, Koichi Yoshinaga, Yuji Hirasaki, Yusuke Iizuka, Yuji Otsuka

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引用次数: 0

Abstract

Background: Interatrial right-to-left shunt flow through a patent foramen ovale (PFO) can be caused by changes in heart position for anastomosis during off-pump coronary artery bypass (OPCAB). We herein present a case in which the direction of PFO shunt flow changed with heart position during OPCAB and the ventilation settings after sternal closure.

Case presentation: A 66-year-old man with interstitial pneumonia underwent OPCAB. Preoperative transesophageal echocardiography revealed right-to-left shunt flow through a PFO induced by the Valsalva maneuver. During OPCAB, heart displacement resulted in right-to-left shunting and acute hypoxemia, which quickly improved with increase of inspired oxygen fraction. After chest closure, bidirectional shunt flow developed under increased airway pressure.

Conclusions: Vigilant intraoperative monitoring with TEE and postoperative airway pressure management are important to address shunt flow and hypoxemia due to PFO.

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由气道压力变化引起的体外冠状动脉旁路移植术中通过卵圆孔的动态分流量改变：病例报告。

背景：在体外循环冠状动脉搭桥术（OPCAB）中，心脏位置的改变可导致通过卵圆孔（PFO）的房室间右向左分流。我们在此介绍一个病例，该病例在 OPCAB 过程中，PFO 分流流的方向随心脏位置和胸骨闭合后的通气设置而改变：一名患有间质性肺炎的 66 岁男性接受了 OPCAB。术前经食道超声心动图显示，PFO分流流经瓦尔萨尔瓦手法引起的右向左分流。在进行 OPCAB 时，心脏移位导致右向左分流和急性低氧血症，但随着吸入氧分压的增加，情况很快得到改善。关闭胸腔后，在气道压力增加的情况下出现了双向分流：结论：使用 TEE 进行术中严密监测和术后气道压力管理对于解决 PFO 导致的分流和低氧血症非常重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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