Key result
Transcatheter PFO closure resolves right-to-left shunting and hypoxia after transcatheter tricuspid valve replacement.
Case Report (n=1)
No
Patients at high risk for right ventricular dysfunction post-TVR who have a pre-existing PFO are at risk for right-to-left shunting and hypoxemia, which can be successfully treated with percutaneous PFO closure.
Case report supports PFO closure to resolve post-TTVR hypoxia; leaves open need for pre-procedural screening or trials.
BACKGROUND: Transcatheter tricuspid valve replacement (TVR) is used to treat patients with severe symptomatic tricuspid regurgitation (TR) despite optimal medical therapy (OMT). We describe a case of right ventricular (RV) failure after TVR presenting with hypoxia due to reversal of shunt through a pre-existent patent foramen ovale (PFO). CASE SUMMARY: A 76-year-old woman with severe symptomatic TR underwent TVR. She presented 5 days after discharge with hypoxia. Her prosthetic valve was functioning well. She had persistent RV dysfunction and a right to left shunt via PFO. She underwent transcatheter closure of her PFO with resolution of her hypoxia. DISCUSSION: There have been no reported cases of PFO causing hypoxia due to reversal of shunt post-TVR. We hypothesize that the hypoxia post-TVR was related to post-TVR RV failure. TAKE-HOME MESSAGE: PFO closure at the time of TVR can prevent hypoxia in patients at risk for RV dysfunction.
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Kreyden et al. (2026) conducted a case report in Severe symptomatic tricuspid regurgitation and patent foramen ovale (n=1). Transcatheter patent foramen ovale (PFO) closure was evaluated on Resolution of hypoxia and oxygen requirement. Transcatheter closure of a patent foramen ovale effectively resolved hypoxia caused by right-to-left shunt reversal following transcatheter tricuspid valve replacement.
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