{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T22:08:16Z","timestamp":1761862096854},"reference-count":9,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2001,12,24]],"date-time":"2001-12-24T00:00:00Z","timestamp":1009152000000},"content-version":"vor","delay-in-days":723,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2000,1]]},"abstract":"<jats:p>We report a 56\u2010year\u2010old male patient developing hypoxemia after surgical replacement of infected valves of a left ventricular assist device (LVAD, Novacor<jats:sup>TM<\/jats:sup>) which had supported him during the previous 15 months. Contrast transesophageal echocardiography (TEE) revealed an atrial septal defect with intermittent right\u2010to\u2010left shunt across a patent foramen ovale.<\/jats:p><jats:p>We postulate that the shunt detected in this patient occurred as a consequence of reduced pulmonary vascular compliance due to positive end\u2010expiratory pressure (PEEP) and an increase of mean intrathoracic pressure. Furthermore, we hypothesize that synchronized LVAD operation exacerbates any potential right\u2010to\u2010left shunt due to the profound left ventricular unloading which occurs during LVAD support.<\/jats:p><jats:p>In this first report of a right\u2010to\u2010left shunt from a previously unrecognized patent foramen ovale in a Novacor<jats:sup>TM<\/jats:sup> patient, the subsequent transient hypoxemia could be managed by avoiding PEEP of more than 3 mmHg, and mean airway pressure of more than 11 mmHg and by careful volume replacement in order to prevent the pump from completely emptying the left ventricle (LV) and the left atrium (LA). Thus, prior to every LVAD implantation a transesophageal contrast echocardiography with Valsalva maneuver should be performed to identify intracardiac right\u2010to\u2010left shunt.<\/jats:p>","DOI":"10.1034\/j.1399-6576.2000.440122.x","type":"journal-article","created":{"date-parts":[[2003,3,10]],"date-time":"2003-03-10T09:40:36Z","timestamp":1047289236000},"page":"125-127","source":"Crossref","is-referenced-by-count":32,"title":["Intermittent atrial level right\u2010to\u2010left shunt with temporary hypoxemia in a patient during support with a left ventricular assist device"],"prefix":"10.1111","volume":"44","author":[{"given":"E.","family":"Kilger","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Strom","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.","family":"Frey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.W.","family":"Felbinger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.","family":"Pichler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Tichy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N.","family":"Rank","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"Wheeldon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K.","family":"Kesel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Schmitz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H.","family":"Reichenspurner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Polasek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"Weis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. 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