JACC Case Rep. 2025 Oct 8;30(31):105301. doi: 10.1016/j.jaccas.2025.105301.
ABSTRACT
BACKGROUND: Right-to-left shunting through a patent foramen ovale (PFO) can cause severe hypoxemia in right ventricular (RV) failure; however, closure may worsen RV function and risk hemodynamic collapse.
CASE SUMMARY: A 40-year-old man with arrhythmogenic RV dysplasia and profound RV failure developed refractory hypoxemia due to a large PFO while supported on venoarterial extracorporeal membrane oxygenation and intra-aortic balloon pump. After multidisciplinary assessment, he underwent successful percutaneous PFO closure, leading to improved oxygenation, RV stability, and decannulation from mechanical circulatory support.
DISCUSSION: This rare case involving dual mechanical support illustrates the complexity of managing PFOs in RV failure. It challenges conventional caution against closure and emphasizes the importance of individualized, team-based decision-making guided by careful physiological assessment.
TAKE-HOME MESSAGES: PFO closure may be feasible in RV failure with mechanical circulatory support. Multidisciplinary planning is essential to optimize outcomes.
PMID:41072984 | PMC:PMC12516283 | DOI:10.1016/j.jaccas.2025.105301