Delayed intracardial shunting and hypoxemia after massive pulmonary embolism in a patient with a biventricular assist device

Journal of Cardiothoracic Surgery

Michael Irlbeck³  Ralf Sodian¹  Peter Boekstegers²  Dirk Bruegger³  Lorenz Frey³  Michael E Dolch³  Thomas Weig³ 

[1] Department of Cardiovascular Surgery, Ludwig-Maximilians-University, Munich, Germany;Department of Cardiology, Helios Klinikum Siegburg, Siegburg, Germany;Department of Anaesthesiology, Ludwig-Maximilians-University, Munich, Germany

关键词: septal occluder device;    heart transplantation;    ventricle-assist device;    pulmonary embolism;    hypoxemia;    patent foramen ovale;   

Others  :  1207734
DOI  :  10.1186/1749-8090-6-133

 received in 2011-08-19, accepted in 2011-10-11,  发布年份 2011

【 摘 要 】

We describe the interdisciplinary management of a 34-year-old woman with dilated cardiomyopathy three months postpartum on a cardiac biventricular assist device (BVAD) as bridge to heart transplantation with delayed onset of intracardial shunting and subsequent hypoxemia due to massive pulmonary embolism. After emergency surgical embolectomy pulmonary function was highly compromised (PaO₂/FiO₂ 54) requiring bifemoral veno-venous extracorporeal membrane oxygenation. Transesophageal echocardiography detected atrial level hypoxemic right-to-left shunting through a patent foramen ovale (PFO). Percutaneous closure of the PFO was achieved with a PFO occluder device. After placing the PFO occluder device oxygenation increased significantly (Δ p_aO₂ 119 Torr). The patient received heart transplantation 20 weeks after BVAD implantation and was discharged from ICU 3 weeks after transplantation.

An increase in pulmonary vascular resistance in patients on BVAD can reopen a PFO resulting in atrial right-to-left shunting and subsequent hypoxemia. The case demonstrates the usefulness of transesophageal echocardiography examinations in the detection of this unexpected event. Percutaneous placement of a PFO occluder device is an appropriate strategy to stop intracardiac shunting through PFO in fixed elevation of pulmonary vascular resistance.

【 授权许可】

   
2011 Weig et al; licensee BioMed Central Ltd.

【 图 表 】

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