Teng Peng, Zhao Haige, Yuan Shuai, Lou Guoliang, Wu Shengjun
Department of Cardiovascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China.
Department of Echocardiography and Vascular Ultrasound Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China.
Heliyon. 2023 Feb 9;9(2):e13556. doi: 10.1016/j.heliyon.2023.e13556. eCollection 2023 Feb.
The prevalence of patent foramen ovale (PFO) is 20-25% among adults. The role of right-to-left shunting through the PFO in systemic hypoxemia remains poorly understood. Right-to-left shunting through the PFO can occur either due to elevated right atrial pressure (pressure-driven) or directed venous flow toward the PFO (flow-driven). Herein, we report a rare case of flow-driven right-to-left shunting via the PFO in a patient with traumatic tricuspid regurgitation. A 45-year-old Chinese woman was admitted due to progressive dyspnea for 3 years, presenting with cyanosis and digital clubbing. She was hypoxic, with an oxygen saturation of 83% on room air, and arterial blood gas showed an oxygen tension of 53 mmHg. Echocardiography showed severe tricuspid regurgitation with ruptured chordae tendinea, causing regurgitant jet flow directed toward the interatrial septum, leading to intermittent right-to-left shunting between the septa primum and secundum. Swan-Ganz catheterization revealed normal-high right atrial pressure and excluded pulmonary hypertension. The patient underwent tricuspid valve repair and PFO closure. Her oxygen saturation returned to 95% and her symptoms resolved. Right-to-left shunting through the PFO could cause systemic hypoxemia via a flow-driven mechanism, occasionally manifesting as cyanosis and clubbing digits. PFO closure and treatment of underlying disease are effective in improving hypoxemia.
成年人卵圆孔未闭（PFO）的患病率为20%-25%。经PFO的右向左分流在系统性低氧血症中的作用仍知之甚少。经PFO的右向左分流可由于右心房压力升高（压力驱动）或静脉血流朝向PFO（血流驱动）而发生。在此，我们报告一例创伤性三尖瓣反流患者中罕见的经PFO血流驱动的右向左分流病例。一名45岁中国女性因进行性呼吸困难3年入院，伴有发绀和杵状指。她存在低氧血症，室内空气下氧饱和度为83%，动脉血气显示氧分压为53 mmHg。超声心动图显示严重三尖瓣反流伴腱索断裂，导致反流束射向房间隔，引起原发隔和继发隔之间间歇性右向左分流。 Swan-Ganz导管检查显示右心房压力正常偏高，排除了肺动脉高压。该患者接受了三尖瓣修复和PFO封堵术。她的氧饱和度恢复到95%，症状得到缓解。经PFO的右向左分流可通过血流驱动机制导致系统性低氧血症，偶尔表现为发绀和杵状指。PFO封堵和基础疾病的治疗对改善低氧血症有效。
