Honda Ayano, Yoshinaga Koichi, Hirasaki Yuji, Iizuka Yusuke, Otsuka Yuji
Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-Cho, Omiya-Ku, Saitama-Shi, Saitama, 330-8503, Japan.
Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi, 329-0498, Japan.
JA Clin Rep. 2024 Oct 15;10(1):65. doi: 10.1186/s40981-024-00748-7.
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.
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.
Vigilant intraoperative monitoring with TEE and postoperative airway pressure management are important to address shunt flow and hypoxemia due to PFO.
在非体外循环冠状动脉搭桥术（OPCAB）期间，心脏位置改变以进行吻合时，可导致经卵圆孔未闭（PFO）的心房右向左分流。在此，我们报告一例在OPCAB期间PFO分流方向随心脏位置以及胸骨关闭后的通气设置而改变的病例。
一名66岁间质性肺炎男性患者接受了OPCAB。术前经食管超声心动图显示在瓦尔萨尔瓦动作诱发下经PFO的右向左分流。在OPCAB期间，心脏移位导致右向左分流和急性低氧血症，随着吸入氧分数增加迅速改善。胸部关闭后，在气道压力增加的情况下出现双向分流。
术中使用经食管超声心动图进行密切监测以及术后气道压力管理对于处理因PFO导致的分流和低氧血症很重要。
