Transcatheter Closure of Patent Foramen Ovale after Left Ventricular Assist Device Implantation: Intraoperative Decision Making

Kavarana, Minoo N.; Rahman, Faraaz; Recto, Michael R.; Dowling, Robert D.

doi:10.1016/j.healun.2005.02.007

Cited by 13 publications

(7 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several authors have reported the discovery of intraatrial communications with significant right to left shunting when patients with congestive heart failure with severely elevated left atrial pressure undergo abrupt reduction in pressure following cannulation with a LVAD. Infrequent case reports have described the successful closure of those defects discovered after LVAD placement with atrial septal occluder devices [4–6]. Others have identified clinically significant iatrogenic ASDs after percutaneous transseptal balloon mitral valvuloplasty, which were closed using a septal occluder device as well [7–10].…”

Section: Discussionmentioning

confidence: 99%

Monoclonal antibody interactions with micro- and nanoparticles: Adsorption, aggregation, and accelerated stress studies

Bee

Chiu

Sawicki

et al. 2009

Journal of Pharmaceutical Sciences

133

125

View full text Add to dashboard Cite

Therapeutic proteins are exposed to various wetted surfaces that could shed sub-visible particles. In this work we measured the adsorption of a monoclonal antibody (mAb) to various microparticles, characterized the adsorbed mAb secondary structure, and determined the reversibility of adsorption. We also developed and used a front-face fluorescence quenching method to determine that the mAb tertiary structure was near-native when adsorbed to glass, cellulose and silica. Initial adsorption to each of the materials tested was rapid. During incubation studies, exposure to the air-water interface was a significant cause of aggregation but acted independently of the effects of microparticles. Incubations with glass, cellulose, stainless steel or Fe 2 O 3 microparticles gave very different results. Cellulose preferentially adsorbed aggregates from solution. Glass and Fe 2 O 3 adsorbed the mAb but did not cause aggregation. Adsorption to stainless steel microparticles was irreversible, and caused appearance of soluble aggregates upon incubation. The secondary structure of mAb adsorbed to glass and cellulose was near-native. We suggest that the protocol described in this work could be a useful preformulation stress screening tool to determine the sensitivity of a therapeutic protein to exposure to common surfaces encountered during processing and storage.

show abstract

Section: Discussionmentioning

confidence: 99%

Monoclonal antibody interactions with micro- and nanoparticles: Adsorption, aggregation, and accelerated stress studies

Bee

Chiu

Sawicki

et al. 2009

Journal of Pharmaceutical Sciences

133

125

View full text Add to dashboard Cite

show abstract

“…If PFO is detected before weaning from cardiopulmonary bypass, immediate operative closure is recommended. If shunting is detected after weaning from cardiopulmonary bypass, delayed interventional closure after stabilization is preferred if oxygenation failure is tolerable, since failure of the right heart in LVAD implantation or bleeding complications due to coagulopathy after reapplied bypass can deteriorate outcome [2]. PFO closure improved oxygenation in all known cases as it did in our patient.…”

Section: Discussionmentioning

confidence: 78%

Delayed intracardial shunting and hypoxemia after massive pulmonary embolism in a patient with a biventricular assist device

Weig

Dolch

Frey

et al. 2011

J Cardiothorac Surg

View full text Add to dashboard Cite

We describe the interdisciplinary management of a 34-year-old woman with dilated cardiomyopathy three months postpartum on a cardiac biventricular assist device (BVAD) as bridge to heart transplantation with delayed onset of intracardial shunting and subsequent hypoxemia due to massive pulmonary embolism. After emergency surgical embolectomy pulmonary function was highly compromised (PaO2/FiO2 54) requiring bifemoral veno-venous extracorporeal membrane oxygenation. Transesophageal echocardiography detected atrial level hypoxemic right-to-left shunting through a patent foramen ovale (PFO). Percutaneous closure of the PFO was achieved with a PFO occluder device. After placing the PFO occluder device oxygenation increased significantly (Δ paO2 119 Torr). The patient received heart transplantation 20 weeks after BVAD implantation and was discharged from ICU 3 weeks after transplantation.An increase in pulmonary vascular resistance in patients on BVAD can reopen a PFO resulting in atrial right-to-left shunting and subsequent hypoxemia. The case demonstrates the usefulness of transesophageal echocardiography examinations in the detection of this unexpected event. Percutaneous placement of a PFO occluder device is an appropriate strategy to stop intracardiac shunting through PFO in fixed elevation of pulmonary vascular resistance.

show abstract

“…Classically, patients present with platypnea-orthodeoxia syndrome, positional hypoxia associated with the sensation of diffi culty breathing, relieved in a recumbent position. Additionally, there are rare reports of acquired rightto-left shunts following cardiac or pulmonary surgery, detailed in Table 1 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Hypoxia secondary to PFO is believed to develop from an abnormal anatomic relation between the vena cava and the atrial septum, which directs venous blood fl ow from the inferior vena cava toward the atrial septum.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Percutaneous Closure of Patent Foramen Ovale for Hypoxia

Munkres

Ball

Chamogeorgakis

et al. 2015

Baylor University Medical Center Proceedings

View full text Add to dashboard Cite

We report a patient with hypoxia secondary to a right-to-left shunt through a patent foramen ovale, following aortic root, valve, and arch replacement due to an aortic dissection in the setting of the Marfan syndrome. Following the operation, he failed extubation twice due to hypoxia. An extensive workup revealed a right-to-left shunt previously not seen. The patent foramen ovale was closed using a percutaneous closure device. Following closure, our patient was extubated without difficulty and has done well postoperatively.A pproximately 25% of the general population is estimated to have a patent foramen ovale (PFO). Th ese small atrial septal defects, present from birth, are usually asymptomatic and found incidentally by echocardiogram or at autopsy (1). We describe the benefi t of closure of a PFO for postoperative hypoxia. CASE DESCRIPTIONA 23-year-old Hispanic man with the Marfan syndrome presented with acute chest pain that radiated to his back. Th e diagnosis of a dilated aortic root and a type B aortic dissection was made quickly by computed tomography scan with contrast. He underwent surgical repair using a two-staged "elephant trunk" procedure. Th e initial stage of the procedure consists of an aortic valve, root, and arch replacement, including leaving an elephant trunk portion of the graft that hangs down into the descending aorta. Finally the descending thoracic aorta is wrapped at that level of the diaphragm. Th e second stage of the procedure uses a stent graft, via an endovascular approach, to connect the elephant trunk with the wrapped portion of the aorta. Following the fi rst stage, his postoperative course was complicated by recurrent hypoxia. He underwent two attempted extubations on postoperative days 1 and 7, but the hypoxia persisted. A PFO with a signifi cant right-to-left shunt was found on transesophageal echocardiogram with bubble study (Figure 1).On postoperative day 9, a percutaneous closure procedure was performed via the right femoral vein. A #25 Amplatzer Cribriform Septal Occluder (AGA Medical Corp., Plymouth, MN) was deployed in the PFO, and placement was confi rmed with intracardiac echocardiography and fl uoroscopy (Figure 2). A negative echocardiographic bubble study at the conclusion of the procedure confi rmed resolution of the right-to-left shunt. On day 10, extubation was successful and normal oxygen saturation was maintained. Th e patient was discharged from the hospital on postoperative day 22. Five weeks later, he underwent stage 2 of the "elephant trunk" procedure without postoperative respiratory complications. He continues to do well 5 months following the second stage of the procedure. DISCUSSIONDespite the severity of potential consequences of a PFO, hypothesized benefi ts of closing PFOs, specifi cally for migraine headaches and strokes, have not resulted in clinical benefi t over standard medical management. Th ree large randomized controlled trials, RESPECT (2), CLOSURE I (3), and PC Trial (4), failed to show a benefi t of PFO closure over medical management fo...

show abstract

Transcatheter Closure of Patent Foramen Ovale after Left Ventricular Assist Device Implantation: Intraoperative Decision Making

Cited by 13 publications

References 5 publications

Monoclonal antibody interactions with micro- and nanoparticles: Adsorption, aggregation, and accelerated stress studies

Monoclonal antibody interactions with micro- and nanoparticles: Adsorption, aggregation, and accelerated stress studies

Delayed intracardial shunting and hypoxemia after massive pulmonary embolism in a patient with a biventricular assist device

Usefulness of Percutaneous Closure of Patent Foramen Ovale for Hypoxia

Contact Info

Product

Resources

About