Concomitant carcinoid heart disease and patent foramen ovale: a case report and review of literature

Carcinoid Heart Disease (CHD) primarily affects the right heart valves, while left heart involvement is rare and often associated with a patent foramen ovale (PFO). Early identification of a PFO in CHD can be critical to patient outcomes. A 61-year-old woman with metastatic neuroendocrine tumor presented with worsening breathlessness and hypoxemia. Imaging excluded pulmonary embolism and lung metastases. Transthoracic echocardiography revealed severe tricuspid regurgitation due to carcinoid valve involvement. Persistent hypoxemia prompted transesophageal echocardiography, which demonstrated a right-to-left shunt through a PFO. Right heart catheterization confirmed the findings excluding significant pulmonary hypertension. Percutaneous PFO closure improved oxygenation, but the patient deteriorated due to right ventricular failure and ultimately died from multiorgan failure despite later tricuspid valve replacement. This case illustrates the importance of early detection of PFO in CHD, as delayed intervention can lead to poor outcomes. Simultaneous PFO closure and valve replacement may be preferable to a staged approach. A multidisciplinary strategy is vital for timely diagnosis and optimal treatment planning in such complex cases.