Home  |  Journals  |  Conferences |   Membership  |   FAQ's Join  |  Contact  |   Sitemap  |             

International Journal of Clinical & Medical Images

ISSN: 2376-0249
Open Access
 
 
 

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

Other Art Works

Image 01 Image 02
Image 03 Image 04
Image 05 Image 06
Image 07 Image 08
Image 09 Image 10
Image 11 Image 12
Image 13 Image 14
Image 15 Image 16
Image 17 Image 18
Image 19 Image 20
Image 21 Image 22
Image 23 Image 24
Image 25 Image 26
Image 27 Image 28
Image 29 Image 30

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.

 
 
© 2008-2013 OMICS Group - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version