Flow Pattern of Outflow Graft is Useful for Detecting Pump Thrombosis in a Patient with Left Ventricular Assist Device
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- Sato Tasuku
- Heart Center, Kyushu University Hospital Department of Health Sciences, Kyushu University Graduate School of Medical Sciences
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- Fujino Takeo
- Department of Advanced Cardiopulmonary Failure, Kyushu University Graduate School of Medical Sciences
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- Higo Taiki
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
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- Ohtani Kisho
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
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- Hiasa Ken-ichi
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
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- Sakamoto Takafumi
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
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- Chishaki Akiko
- Department of Health Sciences, Kyushu University Graduate School of Medical Sciences
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- Shiose Akira
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
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- Tsutsui Hiroyuki
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
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Description
<p>Pump thrombosis (PT) is a serious complication after continuous-flow left ventricular assist device (LVAD) implantation. To detect PT, echocardiographic ramp test using left ventricular end-diastolic diameter (LVEDD) is known to be useful. However, this method has several limitations. In this study, we propose an alternative novel ramp test using the flow velocity of outflow graft (OG). A 46-year-old man underwent continuous-flow LVAD (HeartMate II, Abbott Laboratories, Lake Forest, IL, USA) implantation for advanced heart failure due to idiopathic dilated cardiomyopathy. About 2 years after implantation, he suffered from hemolysis and symptoms of heart failure, and PT was strongly suspected. The change in LVEDD was minimal with increase in pump speed (−0.06 cm/400 rotations per minute (rpm)), suggesting PT. The systolic to diastolic velocity (S/D) ratio of OG flow, which we proposed as a new indicator of PT, also showed minimal change (−0.07/400 rpm). His clinical symptoms improved with anticoagulation therapy, and the changing slope of the S/D ratio dramatically improved to −0.92/400 rpm. Although its consistency should be verified in many other cases, this novel method can be useful for detecting PT and evaluating its clinical course.</p>
Journal
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- International Heart Journal
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International Heart Journal 60 (4), 994-997, 2019-07-30
International Heart Journal Association