Patent Foramen Ovale Closure in Right Ventricular Failure on Mechanical Circulatory Support: To Close or Not?

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.