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Case Reports
. 2018 Dec 3;11(1):bcr2018227944.
doi: 10.1136/bcr-2018-227944.

Tilting the balance: hemidiaphragm paralysis leading to right to left cardiac shunt

Ali Raza Ghani  1 , Mohsin Hamid  1 , Puneet Dhillon  1 , Waqas Ullah  1
Affiliations
Case Reports

Tilting the balance: hemidiaphragm paralysis leading to right to left cardiac shunt

Ali Raza Ghani et al. BMJ Case Rep. .

Abstract

Patent foramen ovale (PFO) is a congenital abnormality present in 25%-30% of healthy adults and rarely leads to any sequelae. 1 2 It is associated with a left-to-right shunt which usually does not lead to any haemodynamic compromise. Occasionally, the shunt can get reversed; that is, right-to-left shunt occurs due to worsening pulmonary hypertension and can lead to persistent hypoxia. It is rare for the shunt reversal to happen in the absence of pulmonary hypertension. Here, we present an exceedingly rare case in a 61-year-old man presenting with hypoxia, was found to have shunt reversal due to unilateral diaphragmatic paralysis. He was successfully treated with PFO closure. The purpose of this report is to consider rare possibilities of PFO shunt reversal when the right-sided heart pressure is normal and to highlight that a simple chest X-ray can be a clue to the diagnosis.

Keywords: cardiovascular medicine; interventional cardiology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Chest X-ray showing elevated right hemidiaphragm.
Figure 2
Figure 2
Transoesophageal echo showing a tunnel-shaped patent foramen ovale.
Figure 3
Figure 3
Doppler flow through the patent foramen ovale.
Figure 4
Figure 4
Three-dimensional view of patent foramen ovale.
See this image and copyright information in PMC

References

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