Acute right to left shunt—Combination of tricuspid valve endocarditis, Chiari network, and ostium secundum atrial septal defect

Szirt, Richard; Youssef, George

doi:10.1016/j.jccase.2017.07.001

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…The dynamic interplay of PFO, TR, and CN is a rare cause of POS. Previously reported cases include an isolated CN, an acute TR related to trauma or endocarditis 4–7 or the combination of PFO and CN. To the best of our knowledge, this is the first case of POS due to the interplay of PFO, TR, and CN.…”

Section: Discussionmentioning

confidence: 99%

A case report of a triad causing platypnoea–orthodeoxia syndrome

Fuertes-Kenneally¹,

Quiles

Sánchez-Quiñones

et al. 2021

European Heart Journal - Case Reports

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Background Platypnoea–orthodeoxia syndrome (POS) is a rare condition characterized by hypoxaemia and dyspnoea when changing from a recumbent to an upright position. Diagnosis requires a high clinical suspicion and is often underdiagnosed. Case summary We report a case of POS in a 50-year-old woman with dyspnoea and new-onset atrial fibrillation. Oxygen saturation and dyspnoea worsened as she changed from a supine to a sitting position (96 vs. 86%, respectively). Transoesophageal echocardiography demonstrated enlargement of both atria and right ventricle with reduced systolic function and a large Chiari network (CN). Colour Doppler discovered severe tricuspid regurgitation with tenting and tethering of the valve leaflets. Finally, a bubble test revealed the cause of POS to be a patent foramen ovale along with the severe tricuspid regurgitant jet moving into the left atrium and favoured by the CN. Surgical closure of the foramen ovale resulted in the resolution of symptoms. Discussion Platypnoea–orthodeoxia syndrome is most commonly caused by a right-to-left shunt through an anatomical defect of the interatrial septum, typically a patent foramen ovale, combined with elevated right atrium pressure. This case illustrates an uncommon cause of POS in the absence of elevated atrium pressure due to the interplay of three key elements: a patent foramen ovale, tricuspid regurgitation, and the CN. Our aim is to alert physicians to the possibility of an intracardiac shunt as the cause of unexplained and/or refractory hypoxaemia related to position changes. Early recognition of this syndrome promotes timely treatment, greatly improving patient outcomes.

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Section: Discussionmentioning

confidence: 99%

A case report of a triad causing platypnoea–orthodeoxia syndrome

Fuertes-Kenneally¹,

Quiles

Sánchez-Quiñones

et al. 2021

European Heart Journal - Case Reports

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“…Generally, flow across an interatrial septal defect is left to right, but transient right to left shunting can occur, particularly with isometric strain ( 4 ) such as with a Valsalva maneuver or coughing. Right-to-left shunting is also associated with high pulmonary pressures as well as other anatomic changes such as thoracic aortic aneurysms, thoracic trauma with tricuspid regurgitation, and mediastinal shifts after thoracic surgery ( 5 ). Right-to-left shunting, although not as common as left-to-right shunting, can lead to profound hypoxemia.…”

Section: Discussionmentioning

confidence: 99%

Obstructing Chiari Network Facilitating Blood Flow Across a Patent Foramen Ovale Causing Hypoxia

et al. 2020

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A 36-year-old man with progressive dyspnea and hypoxia was found to have a large, partially fenestrated Chiari network accelerating blood flow through a patent foramen ovale with preservation of an embryonic right-to-left atrial flow pattern. He underwent successful percutaneous patent foramen ovale closure with resolution of his exertional symptoms. ( Level of Difficulty: Beginner. )

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“…Right to left inter-atrial shunts related to tricuspid valve endocarditis and subsequent severe tricuspid regurgitation have been previously reported [14,15]. In these cases, the regurgitant jet was being directed across an inter-atrial defect, patent foramen ovale or atrial septal defect, causing an acute right to left shunt.…”

Section: Left Atriummentioning

confidence: 99%

Tricuspid Valve Infective Endocarditis

Dagher¹,

Ali²,

Perrin³

et al. 2023

Endocarditis - Diagnosis and Treatment

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The tricuspid valve, which has been known as the “forgotten valve”, must not be ignored in infective endocarditis. Tricuspid valve infective endocarditis is a very complex condition and occurs in a complex patient population. The causative organisms are often highly virulent and patients usually have a history of intravenous drug abuse. Although the success rate of antibiotic therapy is high, certain features or complications may require surgery. Understanding the therapeutic options, the challenges of surgical intervention and the components of the patient-centered longitudinal care plan is crucial in order to minimize the risk of relapse, which is unfortunately not uncommon in these patients.

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Acute right to left shunt—Combination of tricuspid valve endocarditis, Chiari network, and ostium secundum atrial septal defect

Cited by 4 publications

References 8 publications

A case report of a triad causing platypnoea–orthodeoxia syndrome

A case report of a triad causing platypnoea–orthodeoxia syndrome

Obstructing Chiari Network Facilitating Blood Flow Across a Patent Foramen Ovale Causing Hypoxia

Tricuspid Valve Infective Endocarditis

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