Transcatheter closure of atrial septostomy facilitates minimally invasive left ventricular assist device implantation

Abstract Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is effective for resuscitating patients in cardiogenic shock prior to committing to durable mechanical circulatory support. However, patients with severely impaired left ventricular function can develop left ventricular (LV) distension and subsequent pulmonary edema while on VA-ECMO. A percutaneous atrial septostomy can be used to allow left-sided decompression and ameliorate refractory pulmonary edema in this situation. Closure of septal defects is mandatory at the time of left ventricular assist device (LVAD) insertion to avoid right-to-left shunting and refractory hypoxemia. Here we present a case of a patient who required VA-ECMO for cardiogenic shock due to decompensated heart failure. While on VA-ECMO, he developed pulmonary edema, which resolved after a percutaneous atrial septostomy was created. Concurrent transcatheter closure of the atrial septostomy facilitated successful use of a minimally invasive approach to LVAD insertion.