case_images: PMC9969903_01
case_images: PMC9969903_02
case_images: RCA showing diffuse disease (red arrow) with 80% mid-RCA occlusion.. RCA, right coronary artery
case_images: cureus-0015-00000034302-i01.jpg
case_images: PMC9969903_02_cureus-0015-00000034302-i01.jpg
case_images: FIG1
case_images: Left heart catheterization showed triple vessel coronary artery disease with 80% occlusion in the mid right coronary artery (RCA) with diffuse disease (Figure 1).
case_images: Bubble study showing significant right to left shunting across PFO, with complete opacification of the left ventricle at the P2 setting.. PFO, patent foramen ovale
case_images: cureus-0015-00000034302-i02.jpg
case_images: PMC9969903_02_cureus-0015-00000034302-i02.jpg
case_images: FIG2
case_images: The first injection at the P2 setting showed significant RTLS across PFO, with complete opacification of the left ventricle (Figure 2).
case_images: Bubble study showing a significant decrease in the right to left shunting across PFO at P6 setting/Impella RP support.. PFO, patent foramen ovale
case_images: cureus-0015-00000034302-i03.jpg
case_images: PMC9969903_02_cureus-0015-00000034302-i03.jpg
case_images: FIG3
case_images: The second injection repeated at the P6 setting also showed a RTLS, but the density of bubbles in the left side of the heart was significantly less compared to the first injection indicating a decrease of the shunt on Impella support (Figure 3).
case_images: PMC9969903_03
case_images: PMC9969903_04