Hypoxemia from right to left shunting through patent foramen ovale.

We report a patient with severe hypoxemia from a large (41%) right to left shunt through a patent foramen ovale after right ventricular myocardial infarction, and review 18 previous descriptions of patients with right to left shunting through patent foramen ovale. These shunts occur when right atrial pressure is elevated above left atrial pressure, or when the anatomic relationship of the interatrial septum to the inferior vena cava is altered. Since 15-35% of the population have a potentially patent foramen ovale, interatrial right to left shunting may occur more frequently than had previously been recognized, and should be considered in a differential diagnosis of hypoxemia.

Pseudoaneurysm of the left ventricle: an unusual echocardiographic presentation. Review of the literature.

Echocardiography showed a large anterior chamber communicating with the left ventricle cavity through the interventricular septum in a patient with a previous left ventricular aneurysmectomy. At postmortem examination this chamber proved to be an 11-cm diameter pseudoaneurysm that opened into the left ventricle through a 3-cm orifice. A review of the literature showed 67 cases of histologically proven left ventricular pseudoaneurysm, most of which occurred after myocardial infarction and cardiac surgery. Twenty-six of 32 left ventricular pseudoaneurysms were successfully operated upon. Among 35 patients with pseudoaneurysms not operated upon, rupture was a cause of death in 11.