PHONE
+44-7482-878921

International Journal of Clinical & Medical Images

ISSN: 2376-0249

Case Blog - International Journal of Clinical & Medical Images (2014) Volume 1, Issue 9

A Patent Foramen Ovale Saves the Day in a Rare Case of Right Ventricular Outflow Tract Obstruction

A Patent Foramen Ovale Saves the Day in a Rare Case of Right Ventricular Outflow Tract Obstruction

Author(s): Sobia A. Zuberi, Shelley R. Zieroth, Darren H. Freed, Schaffer SA and Francisco J. Cordova

A 46-year-old man with remote anterolateral MI (complicated by VT storm requiring ICD) presented in bi-ventricular heart failure with peripheral eosinophilia and cardiogenic shock. Mechanical ventilation worsened hypoxemia, despite FiO2 of 1.0 and nitric oxide. TTE demonstrated LVEF of 20%, PFO (right-to-left-shunting) and sub-pulmonic RVOTO (Figure 1A, Videos 1 and 2) resulting in additional obstructive shock. The PFO functioned as a RV-vent; percutaneous closure was not performed. TEE showed echogenic material layering the RV, TV, RV lead and sub-pulmonic-valve napkin-ring-lesion causing RVOTO (Figure 1B
and Video 3). Cardiac-MRI demonstrated delayed enhancement (Figure 1C and 1D). Endomyocardial and subsequent surgical biopsies were non-diagnostic. Surgical PFO closure, TV repair, debulking of RV and sub-pulmonic-lesions, and ICD removal were performed. Steroids were discontinued as peripheral eosinophilia had improved prior to initiation. The patient recovered, was discharged home and remains stable. This case demonstrates a PFO functioning as a RV-vent. Closure of the PFO without relieving the RVOTO would have proven
deleterious.

flyer Image
Indexing and Archiving
A generic square placeholder image with rounded corners in a figure.
All published articles are assigned to Digital Object Identifier (DOI)- CrossRef.
A generic square placeholder image with rounded corners in a figure.
All published articles of this journal are included in the indexing and abstracting coverage of: