A 72-year-old man developed platypnea and orthodeoxia 6 days after a right pneumonectomy. Inhalation of 100% oxygen resulted in a PaO2 of 57 torr. Cardiac catheterization demonstrated a 21% right-to-left shunt through a patent foramen ovale despite normal hemodynamics. The pneumonectomy may have caused a change in the mediastinal architecture, allowing venous blood to flow through a previously asymptomatic atrial septal defect. Surgical closure of the lesion alleviated the platypnea and orthodeoxia. (Respir Care 1986;31:1211-1213.)
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