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European Journal of Echocardiography 2007 8(4):259-264; doi:10.1016/j.euje.2006.05.003
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Copyright © 2006, The European Society of Cardiology

Hemidiaphragmatic paralysis: An underestimated etiology of right-to-left shunt through patent foramen ovale?

Julie S. Darchisa,c, Pierre V. Ennezata,*,c, Clément Charbonnela, Jean Marc Auberta, Xavier Gonina, Jean Luc Auffraya, Jean Jacques Baucharta, Thierry Le Tourneaua, Christian Reya, François Godarta, Patrick Goldsteinb and Philippe Assemana

aIntensive Care Unit, Cardiology Hospital, Bd Pr J Leclercq, 59000 Lille, France
bEmergency Department, University Hospital, Lille, France

Received 6 March 2006; received in revised form 11 May 2006; accepted after revision 21 May 2006.

ennezat{at}yahoo.com

* Corresponding author. Tel.: +33 3 20 44 53 30; fax: +33 3 20 44 53 33.


  Abstract

Objective To report a specific pathophysiology of hemidiaphragmatic paralysis that may result in severe hypoxemia.

Design Case series.

Setting Intensive care unit in a cardiology hospital.

Patients The series included three patients with refractory hypoxemia in whom a diagnosis of right-to-left-shunt through a patent foramen ovale was made by contrast echocardiography. The three patients had a complete right hemidiaphragmatic paralysis.

Intervention Permanent percutaneous closure of the patent foramen ovale was successfully proceeded in all cases.

Main result These procedures resulted in complete normalization of arterial oxygen saturation.

Conclusion To our knowledge, only three previous reports have described the association of right-to-left shunt through a patent foramen ovale and hemidiaphragmatic paralysis. Such association may be underestimated.

Keywords: Right-to-left shunt; Patent foramen ovale; Hemidiaphragmatic paralysis

c These authors contributed equally to this work.


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