An 82-year-old man developed acute breathlessness and cyanosis, exacerbated while upright and improved on lying flat (platypnea-orthodeoxia syndrome). Echocardiography revealed acute torrential tricuspid regurgitation due to a flail posterior leaflet leading to right-to-left shunting through a patent foramen ovale (PFO). The patient's symptoms resolved after transcatheter PFO closure and tricuspid valve edge-to-edge repair.
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Transcatheter Repair of Acute Torrential Tricuspid Regurgitation Presenting as Platypnea-Orthodeoxia Syndrome.
JACC Case Rep
March 2025
Department of Cardiology, Oxford University Hospitals, Oxford, United Kingdom. Electronic address:
An 82-year-old man developed acute breathlessness and cyanosis, exacerbated while upright and improved on lying flat (platypnea-orthodeoxia syndrome). Echocardiography revealed acute torrential tricuspid regurgitation due to a flail posterior leaflet leading to right-to-left shunting through a patent foramen ovale (PFO). The patient's symptoms resolved after transcatheter PFO closure and tricuspid valve edge-to-edge repair.
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Article Synopsis
- Papillary muscle rupture is a serious and uncommon complication usually occurring after a heart attack, but it can also be caused by heart procedures.
- The case discussed involves a patient in cardiogenic shock due to severe mitral regurgitation caused by an iatrogenic rupture during a cardiac examination.
- The treatment included using a device called Impella CP to support heart function and an urgent surgery to replace the damaged mitral valve, emphasizing the risks linked to minimally invasive heart procedures.
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