{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T16:55:37Z","timestamp":1786467337861,"version":"build-2736575974"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Ministry of Health - Ricerca Corrente to IRCCS MultiMedica"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Dyspnoea is a cardinal clinical feature of post-cardiac surgery patients and represents one of the most significant postoperative complications, whether of cardiac or pulmonary origin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>We report the case of a 52-year-old woman with mitral valve prolapse with severe regurgitation and a moderate-to-severe tricuspid regurgitation, who underwent mitral and tricuspid valvuloplasty using the Guiraudon approach. In the late postoperative phase, during cardiac rehabilitation, the patient experienced dyspnoea during low-intensity exercise associated with significant oxygen desaturation. A surgical technique-guided transthoracic echocardiography revealed a large atrial septal suture dehiscence (ASSD) with a significant bidirectional shunt, which was confirmed by transoesophageal echocardiography. An expert-performed cardiopulmonary exercise testing confirmed the pathophysiological link between ASSD and oxyhaemoglobin desaturation during effort. The patient subsequently underwent a second cardiac surgery to repair the ASSD, which led to the resolution of symptoms and a significant improvement in functional capacity, without further oxygen desaturation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case underscores the importance of a multiparametric diagnostic approach and integrating expert-performed imaging and surgical technique-guided assessments in addressing the common challenge of post-cardiac surgery dyspnoea. The cardiac rehabilitation setting provides an ideal multidisciplinary environment for early detection and effective management of such complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag574","type":"journal-article","created":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T12:07:45Z","timestamp":1785586065000},"source":"Crossref","is-referenced-by-count":0,"title":["An unusual cause of exercise dyspnoea and hypoxia after cardiac surgery: a case report"],"prefix":"10.1093","volume":"10","author":[{"given":"Silvia","family":"Di Marco","sequence":"first","affiliation":[{"name":"IRCCS Multimedica , Via Fantoli 16\/15, Milan 20138 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0954-9871","authenticated-orcid":false,"given":"Gaia","family":"Cattadori","sequence":"additional","affiliation":[{"name":"IRCCS Multimedica , Via Fantoli 16\/15, Milan 20138 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