{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:40:10Z","timestamp":1756280410808,"version":"3.44.0"},"reference-count":3,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,5,21]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:p>A female patient in mid-60s presented with progressive dyspnoea over several months and persistent hypoxia, requiring high-flow supplemental oxygen due to type 1 respiratory failure. Imaging investigations revealed metastatic carcinoid syndrome affecting the tricuspid valve, which led to severe tricuspid regurgitation (TR) directed towards a patent foramen ovale (PFO). A bubble study demonstrated a significant spontaneous right-to-left shunt through the PFO. Right heart catheterisation ruled out significant elevation of right-sided cardiac pressures as a cause of the right-to-left shunt. Thus, the patient\u2019s hypoxia was attributed to the severe TR, with the regurgitant jet directed towards the PFO, resulting in a shunt despite normal right-sided cardiac pressures. The patient underwent successful closure of the PFO, leading to an immediate improvement in oxygen saturation and facilitating the weaning of supplemental oxygen.<\/jats:p>","DOI":"10.1136\/bcr-2024-264435","type":"journal-article","created":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T23:45:12Z","timestamp":1749599112000},"page":"e264435","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["PFO closure in a patient with hypoxia due to tricuspid valve regurgitation and flow-driven shunt"],"prefix":"10.1136","volume":"18","author":[{"given":"Ahmed","family":"Abdel Hafez","sequence":"first","affiliation":[{"name":"Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Khoo","sequence":"additional","affiliation":[{"name":"University Hospitals of Leicester NHS Trust, Leicester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kassem","family":"Safwan","sequence":"additional","affiliation":[{"name":"University Hospitals of Leicester NHS Trust, Leicester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Loke","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adeogo","family":"Olusan","sequence":"additional","affiliation":[{"name":"University Hospitals of Leicester NHS Trust, Leicester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Kovac","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanjay","family":"Bhandari","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,6,10]]},"reference":[{"key":"2025082700075104000_18.6.e264435.1","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2023.e13556","article-title":"Tricuspid-regurgitation-mediated flow-driven right-to-left cardiac shunting caused systemic hypoxemia in a patient with patent foramen ovale without elevated right atrial pressure","volume":"9","author":"Teng","year":"2023","journal-title":"Heliyon"},{"key":"2025082700075104000_18.6.e264435.2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/ehjcr\/ytaa301","article-title":"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","volume":"4","author":"Dherange","year":"2020","journal-title":"Eur Heart J Case Rep"},{"key":"2025082700075104000_18.6.e264435.3","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa701"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-264435","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:07:59Z","timestamp":1756278479000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-264435"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":3,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,10]]},"published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1136\/bcr-2024-264435"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-264435","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,6]]}}}