Transcatheter closure of patent foramen ovale accompanying right-to-left shunt during Impella support.

We experienced a 65-year-old woman who was diagnosed as fulminant myocarditis and transferred on mechanical ventilator and veno-arterial extracorporeal membrane oxygenation (ECMO) supports. Impella 5.0 support was additionally initiated to improve pulmonary edema and unload left ventricle. We found a patent foramen ovale (PFO) at the time of Impella insertion by transesophageal echocardiography. Follow-up transesophageal echocardiography found a development of right-to-left shunt flow through PFO accompanying central hypoxia during Impella P8 support. Veno-arterial ECMO was converted to veno-arterio-venous ECMO and PFO was occluded percutaneously on the next day, which stabilized hemodynamics and systemic oxygen supply. In case of Impella 5.0 support, the existence of PFO and the development of right-to-left shunt flow should be carefully surveyed and closed immediately to maintain hemodynamics and systemic oxygen supply. © 2021. The Japanese Society for Artificial Organs.

Citation

Makiko Nakamura, Teruhiko Imamura, Takuya Fukui, Shuhei Tanaka, Nobuyuki Fukuda, Hiroshi Ueno, Shigeki Yokoyama, Toshio Doi, Kazuaki Fukahara, Koichiro Kinugawa. Transcatheter closure of patent foramen ovale accompanying right-to-left shunt during Impella support. Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs. 2022 Sep;25(3):262-265

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PMID: 35064387

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