Right-to-left flow through a patent foramen ovale in acute right ventricular infarction. Two case reports and a proposal for management

Chest. 1995 Nov;108(5):1468-71. doi: 10.1378/chest.108.5.1468.


Right-to-left shunting through a foramen ovale complicating acute right ventricular infarction and resulting in severe arterial hypoxemia has been described eight times before. Treatment strategies have often aimed at reducing the shunt. Four patients died. Less attention has been paid to attempts at revascularization and, despite a high incidence of atrioventricular conduction disturbances, to temporary dual-chamber pacing. We describe herein two patients with postcardiac surgical right ventricular infarction complicated by severe right-to-left interatrial shunting. Treatment strategy was aimed at improving right ventricular function, and right-to-left shunting ceased. All efforts should be directed at treating right ventricular dysfunction, which is the cause of the clinical picture, and not at reducing the shunt, which is a secondary phenomenon.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Angioplasty, Balloon, Coronary
  • Coronary Circulation*
  • Female
  • Heart Septal Defects, Atrial / complications
  • Heart Septal Defects, Atrial / physiopathology*
  • Heart Ventricles
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / complications
  • Myocardial Infarction / physiopathology*
  • Ventricular Dysfunction, Right / complications
  • Ventricular Dysfunction, Right / therapy*