Percutaneous left ventricular assist device complicated by a patent foramen ovale: importance of identification and management.

Recently, the TandemHeart percutaneous left ventricular assist device (pVAD) has become available as a means to both resuscitate and support patients in cardiogenic shock pending myocardial recovery or definitive surgical or percutaneous intervention. Hypoxia during pVAD support may arise from multiple pulmonary etiologies, including pulmonary edema and mechanisms resulting in right-to-left shunting. We report two cases of patients supported by pVADs in who patent foramen ovale (PFO) present as right-to-left shunts following initiation of TandemHeart support. A review of the mechanisms and hemodynamics resulting in PFO patency during pVAD support as well as suggestions for management are presented.