da Conceição Nicolau Madogolele Heleutério, Ribeiro Dias Barroso Manuela Cristina, Guazzelli Danielle Louvet, Marcondes-Braga Fabiana G, Aulicino Gabriel, Avila Mônica, Magini Sandrigo, Gaiotto Fábio António, Bacal Ferando
Núcleo de Transplante Cardíaco do Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Instituto do Coração de Maputo, Maputo, Mozambique.
Núcleo de Transplante Cardíaco do Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
JACC Case Rep. 2025 Sep 17;30(28):105370. doi: 10.1016/j.jaccas.2025.105370.
Patent foramen ovale (PFO) is a common congenital anomaly that may contribute to hypoxemia and dyspnea.
A 53-year-old woman presented with progressive platypnea and hypoxemia 21 years after orthotopic heart transplantation. Initial assessment revealed moderate tricuspid regurgitation (TR) and a PFO with left-to-right shunting. One year later, worsening dyspnea and desaturation were noted, with imaging confirming severe TR, right atrial dilation, and reversal of shunting to a right-to-left (pulmonary-to -systemic blood flow ratio: 0.79). Surgical tricuspid valve repair and PFO closure were performed, leading to complete symptom resolution and improved oxygenation.
This case highlights the dynamic relationship between TR and PFO shunt reversal in a cardiac transplant recipient. The literature supports PFO closure in symptomatic individuals, particularly when progressive TR contributes to volume overload and oxygenation impairment.
TAKE-HOME MESSAGES: PFO should be considered in cardiac transplant recipients with unexplained dyspnea. Surgical closure is effective when percutaneous intervention is not feasible.
