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Clinical Investigations: CARDIOLOGY |

Partial Pressure of Oxygen Is Lower in the Left Upper Pulmonary Vein Than in the Right in Adults With Atrial Septal Defect*: Difference in Po2 Between the Right and Left Pulmonary Veins

Kanji Iga, MD; Chisato Izumi, MD; Masahiko Matsumura, MD; Shouji Kitaguchi, MD; Yoshihiro Himura, MD; Hiromitsu Gen, MD; Takashi Konishi, MD
Author and Funding Information

*From the Department of Cardiology (Drs. Iga, Izumi, Kitaguchi, Himura, Gen, and Konishi), and the Department of Pediatrics (Dr. Matsumura), Tenri Hospital, Tenri City, Japan.



Chest. 1999;115(3):679-683. doi:10.1378/chest.115.3.679
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Background: The right-to-left shunt at the atrial level is responsible for arterial hypoxemia in patients with atrial septal defect.

Objectives: This study investigated the mechanism of arterial hypoxemia in patients with atrial septal defect by measuring the Po2 in both the right and left upper pulmonary veins.

Subjects and method: We prospectively measured the Po2 in the femoral artery and the right and left upper pulmonary veins during cardiac catheterization in 13 adults (median age, 53 years) and 7 children (median age, 7 years) with secundum atrial septal defect. The adults and children were studied consecutively. Contrast echocardiography was performed to evaluate right-to-left shunt in all adults.

Results: Among the children, there were no patients showing arterial hypoxemia, and there was no difference in the Po2 (± SD) between the right and left upper pulmonary veins (right, 100 ± 3.8 mm Hg vs left, 100 ± 7.8 mm Hg; p = 0.92). However, arterial hypoxemia was present in 11 of the 13 adult patients, although contrast echocardiography showed more than a moderate degree of right-to-left shunt in only four adults. The Po2 was lower in the left upper pulmonary vein than it was in the right upper pulmonary vein in all adult patients (right, 91.6 ± 13.8 mm Hg vs left, 73.0 ± 11.5 mm Hg; p < 0.0001).

Conclusion: The Po2 was lower in the left upper pulmonary vein than it was in the right upper pulmonary vein in adults with atrial septal defect. Care must be taken in measuring pulmonary blood flow if the Po2 in the left upper pulmonary vein is low enough to influence oxygen content. The decreased Po2 in the left upper pulmonary vein may contribute to arterial hypoxemia in addition to right-to-left shunt at the atrial level in adults with atrial septal defect.

Abbreviations: ASD = atrial septal defect; VC = vital capacity; V̇/Q̇ = ventilation/perfusion ratio

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