TY - JOUR
T1 - Stepwise progression of right-to-left atrial shunting
T2 - Through a combination of patent foramen ovale and tricuspid regurgitation
AU - Kransdorf, Evan P.
AU - Kransdorf, Lisa N.
AU - Fortuin, F. David
AU - Sweeney, John P.
AU - Wilansky, Susan
N1 - Publisher Copyright:
© 2016 by the Texas Heart ® Institute, Houston.
PY - 2016/4
Y1 - 2016/4
N2 - Patent foramen ovale is a common clinical finding that generally becomes a concern in the presence of transient ischemic attack or stroke. Rarely, patent foramen ovale is associated with hypoxemia in the presence of substantial right-to-left atrial shunting. We present the case of an 86-year-old woman with a pacemaker, who was initially asymptomatic notwithstanding a patent foramen ovale. Over 1.5 years, her symptoms progressed in a stepwise fashion, in the setting of progressive pacemaker-associated tricuspid regurgitation. Ultimately, the patient’s symptoms and her hypoxemia resolved after percutaneous closure of her patent foramen ovale with use of a 25-mm “Cribriform” occluder device. This case highlights the fact that clinically significant right-to-left shunting requires an anatomic lesion, such as patent foramen ovale, together with elevated right atrial pressure, which in this case was contributed by severe tricuspid regurgitation.
AB - Patent foramen ovale is a common clinical finding that generally becomes a concern in the presence of transient ischemic attack or stroke. Rarely, patent foramen ovale is associated with hypoxemia in the presence of substantial right-to-left atrial shunting. We present the case of an 86-year-old woman with a pacemaker, who was initially asymptomatic notwithstanding a patent foramen ovale. Over 1.5 years, her symptoms progressed in a stepwise fashion, in the setting of progressive pacemaker-associated tricuspid regurgitation. Ultimately, the patient’s symptoms and her hypoxemia resolved after percutaneous closure of her patent foramen ovale with use of a 25-mm “Cribriform” occluder device. This case highlights the fact that clinically significant right-to-left shunting requires an anatomic lesion, such as patent foramen ovale, together with elevated right atrial pressure, which in this case was contributed by severe tricuspid regurgitation.
KW - Echocardiography, transesophageal
KW - Echocardiography, transthoracic
KW - Foramen ovale, patent/complications/physiopathology/therapy
KW - Heart septal defects, atrial
KW - Pacemaker, dual-chamber
KW - Septal occluder device
KW - Tricuspid regurgitation
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UR - http://www.scopus.com/inward/citedby.url?scp=84962760577&partnerID=8YFLogxK
U2 - 10.14503/THIJ-14-4913
DO - 10.14503/THIJ-14-4913
M3 - Article
C2 - 27127438
AN - SCOPUS:84962760577
SN - 0730-2347
VL - 43
SP - 171
EP - 174
JO - Texas Heart Institute Journal
JF - Texas Heart Institute Journal
IS - 2
ER -