Acute hypoxemia due to right-to-left shunt via a patent foramen ovale during left internal thoracic artery to left anterior descending artery anastomosis in off-pump coronary artery bypass grafting: a case report

Yuki Okutomi; Takeyuki Sajima; Atsushi Yasuda; Shigehito Sawamura

doi:10.1186/s40981-023-00607-x

Acute hypoxemia due to right-to-left shunt via a patent foramen ovale during left internal thoracic artery to left anterior descending artery anastomosis in off-pump coronary artery bypass grafting: a case report

JA Clin Rep. 2023 Mar 16;9(1):15. doi: 10.1186/s40981-023-00607-x.

Authors

Yuki Okutomi¹, Takeyuki Sajima², Atsushi Yasuda², Shigehito Sawamura²

Affiliations

¹ Department of Anesthesia and Critical Care, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606, Japan. okutomi.yuki@med.teikyo-u.ac.jp.
² Department of Anesthesia and Critical Care, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606, Japan.

Abstract

Background: A right-to-left shunt via a patent foramen ovale (PFO) during off-pump coronary artery bypass (OPCAB) may result in difficulties in oxygenation and circulatory management. We herein present a case of a marked shunt via a PFO during OPCAB.

Case presentation: A 74-year-old man who had aortic root enlargement, compressing the right atrium, and an atrial septal aneurysm, underwent OPCAB. When the heart was fixed for the anastomosis of the left anterior descending artery, sudden hypoxemia and hypotension were observed. Intraoperative transesophageal echocardiography (TEE) showed a right-to-left shunt via a PFO that was unnoticed preoperatively. After the anastomosis was completed, TEE revealed no shunt through the PFO.

Conclusions: We should check for a PFO in case of an atrial septal aneurysm. Compression of the right atrium is considered an important anatomical risk of the right-to-left shunt in OPCAB.

Keywords: Aortic root enlargement; Atrial septal aneurysm; Hypoxemia; Off-pump coronary artery bypass grafting; Patent foramen ovale; Right-to-left shunt.