Patent Foramen Ovale with Persistent Hypoxaemia and Right-to-left Shunt

We report a case of successful transcatheter closure of patent foramen ovale (PFO) with persistent right-to-left shunt hypoxaemia and multiple emboli. Typically, hypoxaemia due to PFO presents as intermittent platypnoea-orthodeoxia, and PFO closure in older adults has not been recommended. However, age-related changes in the atrial septum can sometimes lead to acquired worsening of the PFO shunt, which can progress to position-independent persistent hypoxaemia. In such cases, PFO closure may be a beneficial treatment, even for older adults.