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Updated: Jan 15, 2026

Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Patent Foramen Ovale Closure in Right Ventricular Failure on Mechanical Circulatory Support: To Close or Not?
Erasmus Mutabi1, Charles Ebersbacher2, Colin Pesyna3
1Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
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.
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