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Interact CardioVasc Thorac Surg 2007;6:778-779. doi:10.1510/icvts.2007.155622
© 2007 European Association of Cardio-Thoracic Surgery
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Christian Schlensak
Friedhelm Beyersdorf
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Right arrow Extracorporeal circulation

Proposal for bail-out procedures - Assisted circulation

Successful interventional closure of a patent foramen ovale in a pediatric patient supported with a biventricular assist device

Florian Loeffelbeina,*, Christian Schlensakb, Friedhelm Beyersdorfb and Sven Dittricha

a Department of Pediatric Cardiology, Children's University Hospital, Freiburg, Mathildenstrasse 1, 79106 Freiburg, Germany
b Department of Cardiovascular Surgery, University Hospital, Freiburg, Hugstetter Strasse 49, 79106 Freiburg, Germany

*Corresponding author. Tel.: +49 761 270 4300.

E-mail address: florian.loeffelbein{at}uniklinik-freiburg.de (F. Loeffelbein).

We report on a 16-year-old boy after an event of cardiac arrest and initial treatment with a veno-arterial extracorporeal membrane oxygenator (ECMO). After a short stabilisation period a biventricular assist device (BVAD, Thoratec) was implanted. Although the BVAD was functioning well, the patient showed persisting hypoxemia. Transthoracic echocardiography revealed a patent foramen ovale with a high right-to-left shunt due to low aspiration pressures of the BVAD. The patient was successfully treated by interventional closure of the PFO with a 27-mm Amplatzer septal occluder and could easily be weaned from the respirator. Meanwhile the boy has successfully undergone heart transplantation. PFO has to be considered as a cause of arterial hypoxemia in patients supported with ventricular assist devices. The diagnosis of a PFO may be missed under ECMO-treatment. Interventional closure of a PFO can successfully be performed even if the patient is supported with a BVAD.

Key Words: Ventricular assist device; ECMO; Patent foramen ovale; Interventional closure; Amplatzer septal occluder; Arterial hypoxemia

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