Cotrim Nuno, Carvalheiro Ricardo, Teixeira Bárbara, Mano Tânia, de Sousa Lídia, Saraiva Mariana, Martins Vítor
Hospital Distrital de Santarém, Santarém, Portugal.
Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
Cardiooncology. 2025 Sep 2;11(1):80. doi: 10.1186/s40959-025-00380-z.
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.
类癌性心脏病（CHD）主要影响右心瓣膜，而左心受累罕见，且常与卵圆孔未闭（PFO）有关。在CHD中早期识别PFO对患者预后可能至关重要。一名61岁患有转移性神经内分泌肿瘤的女性出现呼吸急促和低氧血症加重。影像学检查排除了肺栓塞和肺转移。经胸超声心动图显示由于类癌瓣膜受累导致严重三尖瓣反流。持续的低氧血症促使进行经食管超声心动图检查，结果显示存在通过PFO的右向左分流。右心导管检查证实了这些发现，排除了严重肺动脉高压。经皮PFO封堵改善了氧合，但患者因右心室衰竭病情恶化，尽管后来进行了三尖瓣置换，最终仍死于多器官功能衰竭。
本病例说明了在CHD中早期检测PFO的重要性，因为延迟干预可能导致不良后果。同时进行PFO封堵和瓣膜置换可能比分期方法更可取。多学科策略对于此类复杂病例的及时诊断和最佳治疗规划至关重要。
