Partial PFO Closure for Persistent Hypoxemia in a Patient with Ebstein Anomaly

Area of Science:

• Cardiology
• Congenital Heart Disease

Background:

• Ebstein anomaly involves tricuspid valve deformities and right ventricle atrialization.
• Severe tricuspid regurgitation often necessitates tricuspid valve surgery and atrial septal defect closure.

Purpose of the Study:

• To evaluate the impact of patent foramen ovale closure in a patient with Ebstein anomaly and severe hypoxemia.
• To determine the optimal closure strategy for a patent foramen ovale in the context of Ebstein anomaly and right-to-left shunting.

Main Methods:

• Case presentation of a 73-year-old female with Ebstein anomaly and severe hypoxemia.
• Transthoracic echocardiography to assess tricuspid regurgitation and patent foramen ovale with right-to-left shunting.
• Percutaneous closure of the patent foramen ovale, initially complete then partial.

Main Results:

• Complete percutaneous patent foramen ovale closure resulted in acute decompensation.
• Partial closure of the patent foramen ovale led to hemodynamic stability and improved oxygenation.
• The patient demonstrated "patent foramen ovale dependency" due to longstanding shunts.

Conclusions:

• Partial patent foramen ovale closure can be a beneficial strategy for selected Ebstein anomaly patients with "patent foramen ovale dependency".
• Careful consideration of closure extent is crucial to avoid adverse events in patients with complex congenital heart disease.