Pillai Ashwin, Jedeon Zeina, Hammond Jonathan, Gluck Jason, Jaiswal Abhishek
Department of Internal Medicine, University of Connecticut Health, Farmington, USA.
Department of Cardiology, Hartford Hospital, Hartford, USA.
Cureus. 2024 Jul 24;16(7):e65320. doi: 10.7759/cureus.65320. eCollection 2024 Jul.
Right ventricular failure (RVF) is a common complication that occurs after a left ventricular assist device (LVAD) is implanted. We report an interesting case of severe and refractory hypoxia during the early postoperative period after HeartMate3 (HM3) (Abbott Laboratories, Lake Forest, IL) implantation resulting in the unmasking of a right-to-left intracardiac shunt through a patent foramen ovale (PFO), triggered by early RVF. Importantly, the patient had a small left-to-right shunt after receiving a left-sided Impella 5.5 micro-axial pump (Abiomed, Danvers, MA, USA) pre-LVAD implantation. We observed improved hypoxia but worsening RVF after percutaneous PFO closure, necessitating right-sided mechanical circulatory support. We outline potential reasons for the significant PFO-related shunting seen after HM3 implantation, but not after Impella 5.5 placement. Uncertainty exists regarding the approach to a PFO in patients undergoing LVAD implantation. We propose an approach based on existing literature.
右心室衰竭（RVF）是植入左心室辅助装置（LVAD）后常见的并发症。我们报告了一例有趣的病例，在植入HeartMate3（HM3，雅培公司，伊利诺伊州莱克福里斯特）后的术后早期出现严重且难治性缺氧，导致经卵圆孔未闭（PFO）出现右向左的心内分流，这是由早期右心室衰竭引发的。重要的是，该患者在LVAD植入前接受左侧Impella 5.5微轴泵（美国马萨诸塞州丹弗斯市的Abiomed公司）后存在小的左向右分流。我们观察到经皮闭合PFO后缺氧情况改善，但右心室衰竭恶化，因此需要右侧机械循环支持。我们概述了HM3植入后出现明显的与PFO相关分流而Impella 5.5放置后未出现这种情况的潜在原因。对于接受LVAD植入的患者，处理PFO的方法仍存在不确定性。我们根据现有文献提出一种方法。
