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