Cardiac cause of hypoxaemia in a kyphoscoliotic patient

This report presents the case of a 73 yr-old female in whom kyphoscoliosis, osteoporotic vertebra compression fractures and sternal injury resulted in severe respiratory failure and hypoxaemia, Pulmonary function testing show ed moderate restrictive pattern and rare mismatches were found on lung vent ilation/perfusion scanning. Transoesophageal echocardiography with contrast studies showed abnormal anatomic mediastinal interactions which led to rig ht-to-left interatrial shunt, through patent foremen ovale. First-intention treatment, because of orthopaedic and respiratory surgical restraints, was to close the shunt using transcatheter devices. Follow-up after 6 months d emonstrated that these interauricular umbrella devices corrected arterial h ypoxaemia, True right-to-left interatrial shunts can be found in kyphoscoli otic patients, as a result of thoracic deformation, and can be safely treat ed with percutaneous trancatheter closure.