机械循环支持下的右心衰卵圆孔未闭

Q4 Medicine

JACC. Case reports Pub Date : 2025-10-08 DOI:10.1016/j.jaccas.2025.105301

Erasmus Mutabi MD , Charles Ebersbacher DO , Colin Pesyna MD , Candice Lee MD , Craig Alpert MD , Ryan Watson MD , Karthikeyan Ranganathan MD

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引用次数: 0

摘要

背景：通过卵圆孔未闭（PFO）的右至左分流可导致右心室（RV）衰竭严重的低氧血症；然而，关闭可能会使右心室功能恶化，并有血流动力学崩溃的危险。病例总结：一名40岁男性患者，心律失常性右心室发育不良并严重右心室衰竭，在静脉体外膜氧合和主动脉内球囊泵的支持下，由于大PFO出现难治性低氧血症。经过多学科评估，患者成功进行了经皮PFO闭合术，改善了氧合、右心室稳定性和机械循环支持下的脱管。这个罕见的涉及双机械支持的病例说明了在RV故障中处理pfo的复杂性。它挑战了传统的对封闭的谨慎态度，强调了在仔细的生理评估指导下个性化、团队决策的重要性。在有机械循环支持的RV故障中，espfo闭合可能是可行的。多学科规划对于优化结果至关重要。

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Patent Foramen Ovale Closure in Right Ventricular Failure on Mechanical Circulatory Support

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.