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Hypoxia After Transcatheter Tricuspid Valve Replacement: A Manifestation of Right Ventricular Failure

Victoria A Kreyden¹, Zachary Greiner¹, Simon Gores¹

¹The Christ Hospital, Cincinnati, Ohio, USA.

JACC. Case Reports

|March 16, 2026

Abstract

Background:

Transcatheter tricuspid valve replacement (TVR) is used to treat patients with severe symptomatic tricuspid regurgitation (TR) despite optimal medical therapy (OMT). We describe a case of right ventricular (RV) failure after TVR presenting with hypoxia due to reversal of shunt through a pre-existent patent foramen ovale (PFO).

Case Summary:

A 76-year-old woman with severe symptomatic TR underwent TVR. She presented 5 days after discharge with hypoxia. Her prosthetic valve was functioning well. She had persistent RV dysfunction and a right to left shunt via PFO. She underwent transcatheter closure of her PFO with resolution of her hypoxia.

Discussion:

There have been no reported cases of PFO causing hypoxia due to reversal of shunt post-TVR. We hypothesize that the hypoxia post-TVR was related to post-TVR RV failure.

Take-Home Message:

PFO closure at the time of TVR can prevent hypoxia in patients at risk for RV dysfunction.

Keywords:

hypoxemia right ventricle tricuspid valve

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