title: Stepwise Progression of Right-to-Left Atrial Shunting through a Combination of Patent Foramen Ovale and Tricuspid Regurgitation.
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.
authors.forename: Evan P
authors.initials: EP
authors.lastname: Kransdorf
authors.forename: Lisa N
authors.initials: LN
authors.lastname: Kransdorf
authors.forename: F David
authors.initials: FD
authors.lastname: Fortuin
authors.forename: John P
authors.initials: JP
authors.lastname: Sweeney
authors.forename: Susan
authors.initials: S
authors.lastname: Wilansky
mesh_terms: D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000379:methods; D018450:Disease Progression; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D055989:Septal Occluder Device; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000175:diagnosis* / Q000601:surgery
keywords: Echocardiography, transesophageal; echocardiography, transthoracic; foramen ovale, patent/complications/physiopathology/therapy; heart septal defects, atrial; pacemaker, dual-chamber; septal occluder device; tricuspid regurgitation