Persistent XXXX and platypnea-orthodeoxia after left single-lung transplantation: a case report.

@entity1 @entity64 @entity3126 @entity1353 @entity5663 @entity2704 @entity519 @entity1031 @entity751 @entity813 @entity4616
INTRODUCTION: Platypnea-orthodeoxia is a relatively uncommon but striking clinical syndrome characterized by @entity1353 and deoxygenation accompanying a change to sitting or standing from a recumbent position. @entity519 early after lung transplant can have multiple etiologies. We report a rare case of persistent @entity519 and platypnea-orthodeoxia after left single-lung transplantation, as a result of right-to-left interatrial shunt through a @entity4616 , with subsequent resolution of @entity519 after percutaneous closure of the @entity4616 . CASE PRESENTATION: Our 66-year-old Caucasian male @entity1 exhibited a persistent @entity4616 . Persistent @entity4616 produces an intermittent intra-atrial right-to-left shunt and occurs in approximately 25 % of the general population. Although the majority of @entity1 with @entity4616 are asymptomatic, it is believed to act as a pathway for chemicals or thrombi that can result in a variety of clinical manifestations, including @entity64 , @entity2704 , @entity5663 , @entity3126 , and @entity751 . Percutaneous closure of the @entity4616 has been shown to be effective in the case of right-to-left shunting with normal pulmonary arterial pressure, but the indication remains controversial in other situations where pulmonary pressures are not normal. The most common causes of @entity519 immediately after lung transplant include: @entity813 , reperfusion injury, acute @entity1031 , and acute rejection. We report a case of reopening of a @entity4616 after left single-lung transplantation with normal pulmonary pressure. CONCLUSIONS: Our case demonstrates that an open @entity4616 leading to massive right-to-left shunting is a possible complication after lung transplant, with significant morbidity, and that it can be treated successfully using a percutaneously placed occlusion device. Through this case report, we aim to improve pre-transplant procedures by demonstrating that a bubble contrast transesophageal echocardiogram can be performed pre-operatively to detect a @entity4616 .
