The patient is a 25-year-old woman transferred to Hermann Hospital 3 days after admission to an outlying facility. The patient initially woke up at 3 AM with acute onset of nausea, mild headache, hemoptysis (1⁄4/4 cup of fresh blood), and worsening shortness of breath. She then noticed weakness in the right half of her body associated with dysarthria. She had no associated chest pain or palpita...

a 22-year-old woman presented with acute left-sided pleuritic chest pain and dyspnea 6 days after surgery for revision of the stenotic central aortopulmonary shunt. she had a history of tetralogy of fallot (tof), pulmonary valve stenosis, ventricular septal defect and major aortopulmonary collateral artery. her waterston shunt was placed when she was 5 years old and stented and re-dilated after...

BACKGROUND In right ventricular failure (RVF), an interatrial shunt can relieve symptoms of severe pulmonary hypertension by reducing right ventricular preload and increasing systemic flow. Using a pig model to determine if a pulmonary artery-left atrium shunt (PA-LA) is better than a right atrial-left atrial shunt (RA-LA), we compared the hemodynamic effects and blood gases between the two shu...

In the last decade, a superior mesenteric-intrahepatic left portal shunt (Rex shunt) has been reported for successful management of extrahepatic portal vein obstruction in children. However, in adults, a mesocaval shunt has been generally performed for the surgical management of extrahepatic portal vein obstruction because of the complexity of the underlying disease and the difficulty of the su...

The foramen ovale is considered an unidirectional flap-like valvular structure. Yet, it may increase in size and allow a continuous left-to-right shunt in order to reduce left ventricular filling pressures. We report the case of a 63-year-old woman with hypertrophic cardiomyopathy, referred for percutaneous closure of a coexisting secundum atrial septal defect. Before catheterization, however, ...

We describe a patient with an asymptomatic complete unroofed coronary sinus (CS) syndrome associated with the CS stenosis in the absence of a persistent left superior vena cava (SVC) as identified on coronary computed tomography angiography. There was a large defect between the CS and the left atrium (i.e. a large left-to-right shunt), but an unusual combination of the absence of a persistent l...

BACKGROUND To report a case of impending extrusion of Ex-PRESS shunt treated by shunt-position adjustment. CASE PRESENTATION A 56-year-old Asian woman presented with impending extrusion and malposition of Ex-PRESS shunt in her left eye. The bleb of the left eye was shallow and diffuse. In the past, the patient was treated by Ex-PRESS shunt implantation under the scleral flap in both eyes. The...

A 50-year-old woman with life-long hypoxemia and digital clubbing had a transient ischemic attack at age 47, without identifiable vascular or cardioembolic source. Extensive work-up revealed a 20% anatomic shunt (while breathing 100% oxygen) and evidence of an intrapulmonary shunt (an agitated saline, contrast-enhanced transesophageal echocardiogram showed bubbles in the left atrium and in 3 of...

PURPOSE To evaluate a technique for contrast agent preparation as mixing the patients' blood with agitated saline and to compare it with agitated saline alone in diagnosis of cardiac right-to-left shunt in regard to their sensitivity, time window, and distribution of artificially induced microembolic signals. METHODS Fifty-two patients with stroke who had Transesophageal echocardiography prov...