RIGHT ATRIAL TO LEFT ATRIAL SHUNT THROUGH FORAMEN OVALE DURING PNEUMOPERITONEUM FOR LAPAROSCOPIC CHOLECYSTECTOMY

A 62-year old female patient in whom paradoxical right atrial to left atrial shunt flow through the foramen ovale was detected by transesoph ageal echocardiography during pneumoperitoneum for laparoscopic cholec ystectomy was reported. This patient had a history of mitral valve rep lacement with residual tricuspid valve regurgitation. It was considere d that the onset of paradoxical interatrial shunting through the foram en ovale might be caused not only by mechanical ventilation with posit ive end-expiratory pressure but also by pneumoperitoneum, especially i n patients with heart disease, even if the intra-abdominal pressure wa s maintained at 12 mmHg.