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CARDIOVASCULAR ANESTHESIA

Profound Hypoxemia Resulting from Shunting Across an Inadvertent Atrial Septal Tear After Left Ventricular Assist Device Placement

James E. Baker, MD, FRCP^*, Greg Stratmann, MD, PhD^*, Charles Hoopes, MD, FACS, R. Donateillo, MD^*, Elaine Tseng, MD, FACS, and I. A. Russell, MD, PhD^*

Departments of *Anesthesia and Perioperative Care, and Surgery, University of California, San Francisco, San Francisco, California

Address correspondence to J. E. Baker, Department of Anesthesia and Perioperative Care, University of California, San Francisco, 521 Parnassus Ave., S-455, San Francisco, CA, 94143–0648. Address email to bakerj{at}anesthesia.ucsf.edu

Defects within the interatrial septum (IAS) can be a source of significant right-to-left shunting and hypoxemia, particularly after placement of a left ventricular assist device (LVAD). We report a case of LVAD placement in which an unrecognized IAS tear occurred intraoperatively, leading to profound arterial desaturation. Transesophageal echocardiography (TEE) was instrumental in making the diagnosis. Certain intraoperative events increased the pressure gradient between the right and left atria, aggravating hypoxemia. We recommend that patients undergoing LVAD placement be screened intraoperatively with TEE for unrecognized IAS defects. Re-examination of the IAS should occur on weaning from cardiopulmonary bypass.

IMPLICATIONS: A traumatic atrial septal defect after atrial cannulation caused a right-to-left intracardiac shunt on initiation of left ventricular assist device support that was further aggravated by chest closure and pleural suction, culminating in severe hypoxemia.

This article has been cited by other articles:

				S. Chumnanvej, M. J. Wood, T. E. MacGillivray, and M. F. V. Melo Perioperative Echocardiographic Examination for Ventricular Assist Device Implantation Anesth. Analg., September 1, 2007; 105(3): 583 - 601. [Abstract] [Full Text] [PDF]

				I. El-Magharbel Ventricular Assist Devices and Anesthesia Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2005; 9(3): 241 - 249. [Abstract] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999