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Paradoxical air emboli related to a physiological cardiac right-to-left shunt may cause
Major Finding: Patients who have migraine with aura and a heart with a large right-to-left shunt showed significant deficits in verbal learning and memory, compared with patients with no right-to-left shunting.
The need to quantify right-to-left shunt in acute ischemic stroke: a case-control study.
Right ventricular infarction and acute respiratory failure may create a right-to-left shunt through elevation of right atrial pressure.
Although hypoxemia is a common presenting symptom with multiple causes in the setting of myocardial infarction, the authors present a case resulting from an acute right-to-left shunt secondary to a previously dormant patent foramen ovale.
A PFO with a significant right-to-left shunt was found on transesophageal echocardiogram with bubble study (Figure 1).
Potential treatable cardioembolic sources were detected in 146 (61%) patients: patent foramen ovale with right-to-left shunt (n = 59), left atrial clot (n = 6), left atrial appendage clot (n = 8), and severe thoracic aortic atherosclerotic plaque disease (plaque thickness >4 mm) (n = 79 patients [33%], 56 had an ulcerated plaque and 4 had mobile plaque).
NMT is currently investigating with its CLOSURE I clinical trial, the potential connection between a common heart defect that allows a right-to-left shunt or flow of blood through a defect like a patent foramen ovale (PFO) and brain attacks such as embolic stroke, transient ischemic attacks (TIAs) and migraine headaches.
The cause revolves mostly around an intracardiac right-to-left shunt or intrapulmonary shunts.
Although there is now a considerable right-to-left shunt, the palpable left ventricle, slight pulmonary plethora on chest radiograph, protrusion of the left ventricle behind the inferior vena cava on the lateral film, and large septal Q waves with generous R waves in leads [V.
In rare instances, the LSVC drains directly into the left atrium and may cause a small right-to-left shunt.