RIGHT-TO-LEFT FLOW-THROUGH A PATENT FOREMEN OVALE IN ACUTE RIGHT-VENTRICULAR INFARCTION - 2 CASES REPORTS AND A PROPOSAL FOR MANAGEMENT

Right-to-left shunting through a foramen oval complicating acute right ventricular infarction and resulting in severe arterial hypoxemia has been described eight times before. Treatment strategies have often aimed at reducing the shunt. Four patients died. Less attention has been paid to attempts at revascularization and, despite a high incidence of atrioventricular conduction disturbances, to temporary dual-chamber pacing. We describe herein two patients with postcardiac surgical right ventricular infarction complicated by severe right-to-left interatrial shunting. Treatment strategy was aimed at improving right ventricular function, and right-to-left shunting ceased. All efforts should be directed at treating right ventricular dysfunction, which is the cause of the clinical picture, and not at reducing the shunt, which is a secondary phenomenon.