A young woman being ventilated after surgery in ICU becomes more hypoxic as the PEEP is increased. An echo is performed to assess for a right to left shunt. Surface windows were poor, so we progress to a TOE…
What do you think?
Zoomed 3D view of the inter-atrial septum in the region of the foramen ovale. Note the band in the LA that appears to tether the inter-atrial septum and draw the foramen oval open. Looks like a part of a sewing machine!
Again, zoomed 3D view of the inter-atrial septum in the region of the foramen ovale. Note the band in the LA that appears to attach to the inter-atrial septum and the contralateral wall of the LA
2D view of the inter-atrial septum in the region of the foramen ovale. Colour Flow Doppler demonstrates flow across the PFO. There is a lot of colour artifact in the LA and RV.
Zoomed 2D view of the inter-atrial septum in the region of the foramen ovale. Colour Flow Doppler demonstrates flow across the PFO.
Zoomed 2D view of the inter-atrial septum in the region of the foramen ovale. Colour Flow Doppler demonstrates flow across the PFO.
So there is a PFO, and a left atrial band. The small degree of shunting present is unlikely to contribute substantially to desaturation. With a bit more time, she weans from the ventilator. In the absence of change to the RV, this can be monitored. An occlusion device could be considered should closure be required. Left atrial bands have been associated with cryptogenic stroke; however, there is no evidence of associated thrombus at this time.
Check out:
- A case report: Anomalous bands in the heart: 1972 British Heart journal
- Another case report: Left atrial band: A rare congenital anomaly: 2014 Annals of cardiac anaesthesia
Reviewer: Lloyd Roberts
Tags: LA left atrial band left atrium
