title: Percutaneous closure of a patent foramen ovale to prevent paradoxical thromboembolism in a patient with a continuous-flow LVAD.
abstract: Patent foramen ovale (PFO) may complicate left ventricular assist device (LVAD) therapy. We report a 70-year-old male with a HeartMate II LVAD at increased risk for thromboembolic stroke secondary to a PFO with right-to-left shunting and a large mobile thrombus on his right atrial pacing lead. Via percutaneous intervention, a 25 mm Cribiform Amplatzer atrial septal occluder was successfully deployed across the PFO without complications. This is the first reported case of percutaneous PFO closure to prevent paradoxical thromboembolism in a normoxic patient with an LVAD. In addition, arterial desaturation and the sequelae of chronic hypoxemia were prevented. Strategies to diagnose PFO at the time of LVAD implantation and physiological implications of a right-to-left atrial shunt during mechanical unloading of the failing left ventricle are reviewed.
authors.affiliation: MD/PhD Program, University of Louisville, 201 Abraham Flexner Way, Suite 1200, Louisville, KY 40202 USA.
authors.forename: Carlo R
authors.initials: CR
authors.lastname: Bartoli
authors.forename: Kelly C
authors.initials: KC
authors.lastname: McCants
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Birks
authors.forename: Michael P
authors.initials: MP
authors.lastname: Flaherty
authors.forename: Mark S
authors.initials: MS
authors.lastname: Slaughter
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D009202:Cardiomyopathies / Q000628:therapy*; D054092:Foramen Ovale, Patent / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D055989:Septal Occluder Device; D013923:Thromboembolism / Q000517:prevention & control*; D016896:Treatment Outcome