Ahmed Rizwan
Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
Eur Heart J Case Rep. 2020 Nov 21;4(6):1-5. doi: 10.1093/ehjcr/ytaa453. eCollection 2020 Dec.
Aortic aneurysms are known to cause compression of adjacent structures including the tracheobronchial tree, oesophagus, and recurrent laryngeal nerve. Extremely rarely, they can lead to compression of the tricuspid valve (TV) annulus. We describe a case where aortic aneurysm caused TV annulus compression and persistent right-to-left shunt through a patent foramen ovale (PFO).
A 75-year-old female was admitted with headache and dizziness. On examination, she had persistent arterial desaturation with oxygen levels reduced to 69% at rest whilst breathing ambient air. Complete blood count demonstrated polycythaemia (Hb 174 g/L). Right to left cardiac shunt was suspected after significant lung and haematologic pathology was excluded. Transoesophageal echocardiography demonstrated a trileaflet aortic valve with an ascending aorta aneurysm and a stretched PFO with persistent right to left shunt across it. The ascending aortic aneurysm was observed coursing superior to and compressing the TV annulus. Invasive haemodynamic data demonstrated prominent 'a' waves in the right atrium, low RV (12/1 mmHg), and pulmonary artery pressures (14/6 mmHg), reduced cardiac output and significant right to left shunt with Qp:Qs 0.6. Computed tomography (CT) angiogram demonstrated a 5 cm fusiform ascending aorta aneurysm that coursed anteriorly causing TV annulus compression.
Tricuspid valve inflow obstruction associated with a right to left shunt across PFO can be an extremely rare complication of aortic aneurysm. This may result in persistent arterial hypoxaemia and secondary polycythaemia.
已知主动脉瘤会压迫相邻结构，包括气管支气管树、食管和喉返神经。极其罕见的情况下，它们会导致三尖瓣（TV）瓣环受压。我们描述了一例主动脉瘤导致TV瓣环受压并通过卵圆孔未闭（PFO）出现持续右向左分流的病例。
一名75岁女性因头痛和头晕入院。检查发现，她在呼吸环境空气时静息状态下动脉血氧饱和度持续降低，氧水平降至69%。全血细胞计数显示红细胞增多症（血红蛋白174g/L）。在排除明显的肺部和血液学病变后，怀疑存在右向左心脏分流。经食管超声心动图显示三叶主动脉瓣伴升主动脉瘤以及一个伸展的PFO，有持续的右向左分流通过。观察到升主动脉瘤向上走行并压迫TV瓣环。有创血流动力学数据显示右心房出现明显的“a”波，右心室压低（12/1mmHg），肺动脉压（14/6mmHg），心输出量降低，且有明显的右向左分流，Qp:Qs为0.6。计算机断层扫描（CT）血管造影显示一个5cm的梭形升主动脉瘤向前走行导致TV瓣环受压。
与通过PFO的右向左分流相关的三尖瓣流入道梗阻可能是主动脉瘤极其罕见的并发症。这可能导致持续性动脉低氧血症和继发性红细胞增多症。
