Stepwise progression of right-to-left atrial shunting: Through a combination of patent foramen ovale and tricuspid regurgitation

Evan P. Kransdorf, Lisa N. Kransdorf, F. David Fortuin, John P. Sweeney, Susan Wilansky

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)171-174
Number of pages4
JournalTexas Heart Institute Journal
Volume43
Issue number2
DOIs
StatePublished - Apr 2016

Keywords

  • Echocardiography, transesophageal
  • Echocardiography, transthoracic
  • Foramen ovale, patent/complications/physiopathology/therapy
  • Heart septal defects, atrial
  • Pacemaker, dual-chamber
  • Septal occluder device
  • Tricuspid regurgitation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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