Veno-Venous Extracorporeal Membrane Oxygenation as Bridge to Patent Foramen Ovale Closure for Platypnea-Orthodeoxia Syndrome: A Case Report.

Right-to-left intracardiac shunting may complicate patent foramen ovale, with percutaneous closure being the standard treatment. We present the case of a 63 year old man admitted for percutaneous patent foramen ovale (PFO) closure due to severe right-to-left shunting. Despite treatment with diuretics and noradrenaline, he developed persistent hypoxemia with pulmonary edema. Intubation was initially avoided because of the risk of worsening shunt physiology and anticipated airway management difficulties. To optimize oxygenation while maintaining femoral access for intervention, awake veno-venous extracorporeal membrane oxygenation (ECMO) was initiated, resulting in a marked improvement in oxygenation. The patient subsequently underwent intubation, diagnostic imaging, and successful PFO closure. Extracorporeal membrane oxygenation was weaned 2 days later, and he was discharged from the intensive care unit (ICU) to the ward. This case demonstrates that awake veno-venous ECMO (V-V-ECMO) can serve as a bridging strategy in patients with PFO-related right-to-left shunting when mechanical ventilation carries substantial risks. Careful multidisciplinary evaluation is essential to weigh the potential benefits of ECMO against the risks of cannulation and shunt dynamics.