Percutaneous closure of a patent foramen ovale in left-sided carcinoid heart disease

Chaudhari, Paru R.; Abergel, Jeffrey; Warner, Richard R.P.; Zacks, Jerome; Love, Barry A.; Halperin, Jonathan L.; Adler, Eric

doi:10.1038/ncpcardio0944

Cited by 8 publications

(7 citation statements)

References 14 publications

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“…[6] According to the result of our previous prospective study, all patients with PFO closure presented a reduction of symptoms, but unfortunately, this percutaneous closure can't protect the left heart from serotonin, because of residual right-to-left atrial shunt. Few case reports of PFO closure in CHD have been recently published [7,8] and we believe that this procedure could be particularly of interest in CHD patients with symptomatic PFO but without any planned valvular surgery.…”

Section: Discussionmentioning

confidence: 96%

Patent foramen ovale in carcinoid heart disease

Mansencal

Touhami

Mitry

et al. 2010

International Journal of Cardiology

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Section: Discussionmentioning

confidence: 96%

Patent foramen ovale in carcinoid heart disease

Mansencal

Touhami

Mitry

et al. 2010

International Journal of Cardiology

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“…We report a case of a carcinoid heart disease with a right to left shunt through a PFO resulting in dyspnea and worsening hypoxia that was successfully treated by percutaneous PFO closure that resulted in normalized oxygen saturation, symptomatic relief, and improved quality of life. To our knowledge, there were only five similar reported cases of flow-driven R-L shunting due to the tricuspid regurgitation jet directing deoxygenated blood towards the PFO, resulting in hypoxemia and dyspnea [8,[10][11][12][13][14].…”

Section: Discussionmentioning

confidence: 99%

Relentless Hypoxia in a Patient With Carcinoid Syndrome

Alghamdi¹,

Malibari²,

Al-Husayni³

et al. 2021

Cureus

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Patent foramen ovale (PFO) in patients with carcinoid heart disease (CHD) may result in hypoxia due to the presence of large right (R) to left (L) intracardiac shunts leading to hypoxia and worsening clinical condition. Percutaneous closure of the PFO can normalize oxygen saturation, relieve symptoms, and lessens left-sided heart valves involvement.We describe a case of a 70-year-old female patient with a history of small bowel neuroendocrine tumor on monthly octreotide infusion presented with worsening exertional dyspnea and hypoxia secondary to R to L intracardiac shunt through the PFO. The decision was made to close the PFO percutaneously with Amplatzer (Plymouth, MN: Abbott) PFO occluder device which resulted in immediate normalization of oxygen saturation and relief of her dyspnea.

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“…To our knowledge, there have been three such cases reported in the literature ( Table 2 ). Chaudhari et al 12 reported a case of a patient with carcinoid heart disease causing R-L shunt via flow-driven mechanism due to external compression of the vena cava by tumour mass directing caval blood towards the PFO. The other two cases were reported by Yang et al .…”

Section: Discussionmentioning

confidence: 99%

Flow-driven right-to-left cardiac shunting in a patient with carcinoid heart disease and patent foramen ovale without elevated right atrial pressure: a case report and literature review

Dherange

Telles

Modi

2020

European Heart Journal - Case Reports

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Background Carcinoid heart disease is present in approximately 20% of the patients with carcinoid syndrome and is associated with poor prognosis. It usually manifests with right-sided valvular involvement including tricuspid insufficiency and pulmonary stenosis. Patent foramen ovale (PFO) is present in approximately 50% of the patients with carcinoid heart disease which is twice higher than the general population. Right-to-left shunting through a PFO can occur either due to higher right atrial pressure than left (pressure-driven) or when the venous flow is directed towards the PFO (flow-driven) in the setting of normal intracardiac pressures. We report a rare case of flow-driven right-to-left atrial shunting via PFO in a patient with carcinoid heart disease. Case summary A 54-year-old male with a metastatic neuroendocrine tumour to liver presented with progressive shortness of breath for 5 months. Patient was found to be hypoxic with oxygen saturation of 78% and examination revealed a holosystolic murmur. Arterial blood gas showed oxygen tension of 43 mmHg. A transthoracic and transoesophageal echocardiogram showed aneurysmal inter-atrial septum with a PFO, severe tricuspid regurgitation directed anteriorly towards the inter-atrial septum leading to a marked right-to-left shunt. Right heart catheterization showed right atrial pressure of 8 mmHg, mean pulmonary artery pressure of 12 mmHg, and normal oxygen saturations in the right atrium, right ventricle, and pulmonary arteries. The patient then underwent closure of the PFO along with tricuspid valve and pulmonary valve replacement at an experienced cardiovascular surgical centre and has been asymptomatic since. Conclusion Right-to-left shunting through a PFO in patients with normal right atrial pressure can be successfully treated with closure of the PFO. Thus, understanding the mechanism of intracardiac shunts is important to accurately diagnose and treat this rare and fatal condition.

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Percutaneous closure of a patent foramen ovale in left-sided carcinoid heart disease

Abstract: Percutaneous transcatheter closure of the patent foramen ovale.

Cited by 8 publications

References 14 publications

Patent foramen ovale in carcinoid heart disease

Patent foramen ovale in carcinoid heart disease

Relentless Hypoxia in a Patient With Carcinoid Syndrome

Flow-driven right-to-left cardiac shunting in a patient with carcinoid heart disease and patent foramen ovale without elevated right atrial pressure: a case report and literature review

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