Percutaneous closure of patent foramen ovale for refractory hypoxemia after HeartMate II left ventricular assist device placement

The incidence of probe-patent foramen ovale (PFO) at autopsy is approximately 27% with slit widths ranging from 1 mm to 19 mm (mean 4.9 mm) in diameter. In patients with end-stage heart failure requiring mechanical support, implantation of a left ventricular assist device (LVAD) abruptly decreases diastolic filling pressures and can cause right-to-left shunting with profound systemic hypoxemia. In this report, we describe the first successful PFO closure for refractory hypoxemia after implantation of an axial flow Heartmate II LVAD (Thoratec Corp., Pleasanton, California).