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A patent foramen ovale after heart transplantation is a relatively uncommon occurrence. We report a case of a 58-year-old man with profound hypoxemia after orthotopic cardiac transplantation for end-stage ischemic cardiomyopathy. Transesophageal echocardiography demonstrated the presence of a patent foramen ovale in the recipient atrial cuff. Primary closure was performed with correction of the right-to-left shunt.