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Войти в исследования JACC. Case reports · 2026
Fatal Platypnea-Orthodeoxia Syndrome After Transcatheter Tricuspid Valve Replacement: When HALT Reverses the Shunt.
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Streukens S A F, Peeters F E C M, Theunissen R A L J, Welman M J M, Mihl C, Smulders M W, Vriesendorp P A
Аннотация
BACKGROUND: Hypoattenuated leaflet thickening (HALT) after transcatheter tricuspid valve replacement (TTVR) is increasingly recognized, but its clinical consequences remain incompletely characterized.
CASE SUMMARY: A 63-year-old woman developed severe platypnea-orthodeoxia 5 days after TTVR with the Evoque system. Cardiac computed tomography confirmed HALT of all 3 leaflets. HALT-induced functional stenosis elevated right atrial pressure, reversing a preexisting left-to-right shunt across a secundum atrial septal defect. Low-dose thrombolysis improved oxygen saturation from 69% to 90%, but was complicated by fatal intracranial hemorrhage.
DISCUSSION: Although platypnea-orthodeoxia from bioprosthetic tricuspid valve stenosis with shunt reversal has been described after surgical valve replacement, this represents to our knowledge its first occurrence after TTVR. The case illustrates a previously unrecognized mechanism of hemodynamic compromise and raises the question whether interatrial communications should be considered a relative contraindication for TTVR.
TAKE-HOME MESSAGES: Screening for interatrial communications before TTVR is warranted. Standardized antithrombotic protocols and HALT surveillance strategies are urgently needed.
CASE SUMMARY: A 63-year-old woman developed severe platypnea-orthodeoxia 5 days after TTVR with the Evoque system. Cardiac computed tomography confirmed HALT of all 3 leaflets. HALT-induced functional stenosis elevated right atrial pressure, reversing a preexisting left-to-right shunt across a secundum atrial septal defect. Low-dose thrombolysis improved oxygen saturation from 69% to 90%, but was complicated by fatal intracranial hemorrhage.
DISCUSSION: Although platypnea-orthodeoxia from bioprosthetic tricuspid valve stenosis with shunt reversal has been described after surgical valve replacement, this represents to our knowledge its first occurrence after TTVR. The case illustrates a previously unrecognized mechanism of hemodynamic compromise and raises the question whether interatrial communications should be considered a relative contraindication for TTVR.
TAKE-HOME MESSAGES: Screening for interatrial communications before TTVR is warranted. Standardized antithrombotic protocols and HALT surveillance strategies are urgently needed.