Transseptal TandemHeart‚Ñ¢ Implantation through an Amplatzer Atrial Septal Occluder

Case Presentation. A 52-year-old female was admitted in cardiogenic shock 4 days after multivessel stenting and closure of a grade 3 patent foramen ovale (PFO) with a 25 mm Amplatzer occluder. Diagnostic catheterization was performed under cardiac massage and demonstrated stent thrombosis of the stent in the mid left anterior descending coronary artery (LAD) and the posterolateral branch (PLB) of the right coronary artery (RCA) (Panel A – Arrows). Although TIMI 2 flow was rapidly restored in the LAD (Panel C – Top), the persistence of cardiogenic shock led us to implant a TandemHeart^® percutaneous transseptal left ventricular assist device (pVAD) (CardiacAssist, Inc., Pittsburgh, Pennsylvania). The PFO was crossed with a 6 Fr multipurpose catheter, passing underneath the right atrial disk of the Amplatzer occluder. Subsequently, the 21 Fr left atrial aspiration cannula was placed over an Inoue guidewire into the left atrium (Panel B). A 15 Fr arterial cannula was retrogradely placed in the right femoral artery. The inflow and outflow cannulas were connected to the centrifugal pump rotating at 7,500 rpm. Revascularization of the PLB was performed (Panel C – Bottom), and the patient was transferred in critical but stable condition to intensive care
Implantation of a TandemHeart pVAD is an effective means of restoring hemodynamic stability in patients in cardiogenic shock and has been shown to provide more effective hemodynamic support than the intra-aortic balloon pump. This case demonstrates that a recently implanted Amplatzer PFO Occluder can be easily crossed by the transseptal TandemHeart cannula if required, at least during the first days after the procedure. No embolization of thrombotic material was observed in the present case report. In cases of more remotely implanted devices, a transseptal puncture at the lower rim of the right disk would be the technique of choice.