• Diana Barragan-Bradford, Henning Gaissert, and Vidal MeloMarcos FMFDepartment of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts..
• From the Department of Anesthesia, Critical Care and Pain Medicine.
• A A Pract. 2021 Apr 27; 15 (4): e01454.

AbstractA 75-year-old woman with a history of right-upper lobectomy for adenocarcinoma presented for a right completion pneumonectomy due to 2 new fluorodeoxyglucose-avid densities on the remaining lung. After uneventful anesthetic induction and surgical resection with modest blood loss, the patient developed refractory hypoxemia on emergence without significant hemodynamic changes. Despite delivery of fraction of inspired oxygen (Fio2) = 1.0, confirmed position of the double-lumen tube, and exclusion of common causes of hypoxemia, hypoxemia persisted. An emergent transesophageal echocardiogram revealed a significant intracardiac shunt due to a patent foramen ovale. Specific cardiorespiratory management to achieve a positive left-right heart pressure gradient resulted in prompt normoxemia and successful extubation.Copyright © 2021 International Anesthesia Research Society.

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