Case Report

Learning from a pitfall: Atrial septostomy in LV failure under VA-ECMO for pulmonary hypertension

¹ Cardiothoracic Intensive Care Unit; Marie Lannelongue Hospital, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France
² Department of Pediatric Cardiology, Catheterism and Rythmology, Marie Lannelongue Hospital, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France
³ University Paris-Saclay, Faculty of Medicine, Kremlin-Bicêtre, France
⁴ INSERM U999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Marie Lannelongue Hospital, Le Plessis-Robinson, France
⁵ Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France

^* Corresponding author: This email address is being protected from spambots. You need JavaScript enabled to view it.

Received: 4 November 2025
Accepted: 8 January 2026

Abstract

Background: Atrial septostomy has been successfully used in patients with pulmonary hypertension and in those supported with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) complicated by pulmonary congestion. Case description: We report a patient on VA-ECMO for decompensated pulmonary hypertension who subsequently developed stress-induced cardiomyopathy and pulmonary congestion. An atrial septostomy was performed, which led to worsening respiratory status due to the creation of a right-to-left shunt, and hemodynamic deterioration resulting from increased left ventricular preload. Conclusion: The implications of atrial septostomy should be carefully considered prior to decompression, as there may be situations, especially if right-sided pressures are less than left-sided pressures, where patients may still benefit.