LaBresh K A, Pietro D A, Coates E O, Khuri S F, Folland E D, Parisi A F
Chest. 1981 May;79(5):605-7. doi: 10.1378/chest.79.5.605.
Contrast two-dimensional echocardiography (2DE) was used to demonstrate right-to-left shunting at the atrial level in a 49-year-old man with platypnea and orthostatic cyanosis which developed after a left pneumonectomy. This patient's systemic arterial saturation decreased with phlebotomy and increased with volume administration. This syndrome disappeared after repair of a previously unrecognized atrial septal defect. Right-to-left shunting in atrial septal defect is usually explained by a change in the relationship of right and left ventricular compliance with the right ventricle becoming less compliant (ie, stiffer) than the left. Pneumonectomy can affect atrial emptying either directly by mechanical means or indirectly by changing relationships in ventricular compliance. Contrast 2DE played key role in initially establishing the etiology of cyanosis in this complicated case.
采用对比二维超声心动图（2DE）对一名49岁男性进行检查，该患者在左肺切除术后出现平卧呼吸困难和体位性发绀，检查发现其心房水平存在右向左分流。该患者的体循环动脉血氧饱和度在放血后降低，在补液后升高。在修复先前未被识别的房间隔缺损后，该综合征消失。房间隔缺损中的右向左分流通常被解释为右心室和左心室顺应性关系的改变，即右心室比左心室顺应性更低（即更僵硬）。肺切除术可通过机械手段直接影响心房排空，也可通过改变心室顺应性关系间接影响心房排空。对比2DE在最初确定这一复杂病例中发绀的病因方面发挥了关键作用。
