Right-to-Left Shunting Through a Patent Foramen Ovale Caused by Pulmonary Hypertension Associated with Rheumatoid Arthritis and Sjögren's Syndrome: A Case Report

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Abstract
This case report presents a fifty-four-year-old woman with right-to-left shunt in the atrium. It seemed clinically at first that the shunt was due to atrial septal defect. However, she also had pulmonary disease associated with rheumatoid arthritis and Sjögren's syndrome. At autopsy atrial septal defect was not evident, but a patent foramen ovale and pulmonary artery disease were observed. This case suggests that pulmonary hypertension secondary to rheumatoid arthritis and Sjögren's syndrome could lead to right-to-left shunting through a patent foramen ovale.