PMC9108509_01
Thorax CT scan (coronal view): (A) Dilated ascending aorta (Aao) with right atrial (RA) shape deformation causing interatrial septal distortion. (B) thoracic spine kyphoscoliosis is an accompanying pathologic condition.
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Both a V/Q scan and chest computed tomography (CT) angiography excluded thromboembolism, dilation of pulmonary vessels, and other vascular abnormalities in the lungs and confirmed atelectasis present at the pulmonary bases; furthermore, a spinal deviation and ectatic aorta were evident that associated with an overdeveloped Eustachian valve are conditions facilitating PFO shunting (Fig. 1).
TEE 2D: (A) Interatrial septal with PFO. (B) Same position demonstrating right left shunting with color doppler. (C) Non transpulmonary echocontrast. LA: Left Atrial; RA: Right Atrial; IVC: Inferior Vena Cava. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)
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The patient underwent a contrast transesophageal echocardiography (c-TEE), revealing a significant R-T-L shunt through a 1.1 cm patent foramen oval (PFO) and deviation of the interatrial septum to the left (Fig. 2).
TTE 3D: Left atrial view of interatrial septal (IAS). (A) Large patent foramen ovale (arrow). (B) Effective transcatheter PFO closure with device and residual minimal hole (arrow). LVOT: Left Ventricular Outflow Tract; M: Mitral valve.
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Amplatzer septal occlusion device. Post-procedure three-dimensional transthoracic echocardiography (3D-TTE) showed minimum residual shunting (Fig. 3). At the time of discharge, the patient's SpO2 was at 96% on room air with the ability to maintain moderate exercise.