Service de Pneumologie B et Transplantation Pulmonaire, Hôpital Bichat, Paris, France.
J Heart Lung Transplant. 2010 Feb;29(2):224-7. doi: 10.1016/j.healun.2009.09.009. Epub 2009 Nov 27.
We report the case of a man who underwent a left-lung transplantation for pulmonary fibrosis and who developed deterioration of his respiratory condition at Day 16 post-operatively, with marked hypoxemia not explained by the usual early respiratory complications of lung transplantation. Contrast-enhanced transthoracic echocardiography identified a patent foramen ovale with massive spontaneous right-to-left shunting. As for the pathogenesis of this right-to-left shunting, we found no evidence supporting an elevation of right-side pressures, with the redirection of the inferior vena cava flow toward the patent foramen ovale being the suspected mechanism. We conclude that delayed reopening of the patent foramen ovale leading to massive right-to-left shunting is a possible complication after lung transplantation.
我们报告了一例男性患者，因肺纤维化接受了左肺移植，术后第 16 天呼吸状况恶化，出现明显的低氧血症，无法用肺移植后常见的早期呼吸系统并发症来解释。经胸超声心动图增强检查发现卵圆孔未闭，大量自发性右向左分流。至于这种右向左分流的发病机制，我们没有发现任何证据支持右侧压力升高，下腔静脉血流朝向卵圆孔未闭的再通可能是其机制。我们得出结论，卵圆孔未闭延迟开放导致大量右向左分流是肺移植后的一种可能并发症。
