Hassan Alkhawam1, Rahil Rafeedheen2, Elsayed Abo-Salem2. 1. Center for Comprehensive Cardiovascular care, St Louis University, 3635 Vista Avenue, FDT 13th Floor, Cardiology, St Louis, MO, United States. Electronic address: hassan.alkhawam@health.slu.edu. 2. Center for Comprehensive Cardiovascular care, St Louis University, 3635 Vista Avenue, FDT 13th Floor, Cardiology, St Louis, MO, United States.
Abstract
Right ventricular (RV) dysfunction following surgical implantation of a left ventricular assist device (LVAD) is a well-documented phenomenon, and it is associated with poor outcomes. We are reporting a 25-year-old male patient who presented to the hospital with flu-like symptoms, hypotension and acute hypoxic respiratory failure. The patient's Laboratory data was significant for elevated troponin, and his Chest X-ray showed acute pulmonary edema. Echocardiogram revealed reduced left ventricular (LV) ejection fraction and normal RV function. Coronary angiography was normal, and the cardiac index was 1.3 L/min/m2. Impella 5.0 (Abiomed, MA) was placed through the left axillary artery graft and 4.5 L/min flow was achieved with an improvement in blood pressure. Thirty minutes later, he developed hypotension, the device flow dropped to 3.0 L/min, and right atrial pressure increased. The Pulmonary artery pulsatility index was consistent with RV failure. Possible causes of RV failure include unmasking of RV dysfunction with high LVAD flow and altered RV geometry due to ventricular septum shift. Impella RP (Abiomed, MA) was placed for RV support achieving a flow of 3.8 L/min with a significant improvement in impella LV flow, cardiac output and blood pressure (mean 90 mmHg). Ventricular support devices were weaned off on day 9. The patient was discharged on day 15. Conclusion: our case highlights the risk of RV failure following percutaneous LVAD placement. Early identification and appropriate mechanical support is imperative.
Right ventricular (RV) dysfunction following surgical implantation of a left ventricular assist device (LVAD) is a well-documented phenomenon, and it is associated with poor outcomes. We are reporting a 25-year-old male patient who presented to the hospital with flu-like symptoms, hypotension and acute hypoxic respiratory failure. The patient's Laboratory data was significant for elevated troponin, and his Chest X-ray showed acute pulmonary edema. Echocardiogram revealed reduced left ventricular (LV) ejection fraction and normal RV function. Coronary angiography was normal, and the cardiac index was 1.3 L/min/m2. Impella 5.0 (Abiomed, MA) was placed through the left axillary artery graft and 4.5 L/min flow was achieved with an improvement in blood pressure. Thirty minutes later, he developed hypotension, the device flow dropped to 3.0 L/min, and right atrial pressure increased. The Pulmonary artery pulsatility index was consistent with RV failure. Possible causes of RV failure include unmasking of RV dysfunction with high LVAD flow and altered RV geometry due to ventricular septum shift. Impella RP (Abiomed, MA) was placed for RV support achieving a flow of 3.8 L/min with a significant improvement in impella LV flow, cardiac output and blood pressure (mean 90 mmHg). Ventricular support devices were weaned off on day 9. The patient was discharged on day 15. Conclusion: our case highlights the risk of RV failure following percutaneous LVAD placement. Early identification and appropriate mechanical support is imperative.
Authors: Varinder Kaur Randhawa; Karlee Hoffman; Ashley Bock; Pavan Bhat; Laura Young; Jeffrey Rossi; Joseph Campbell; Corrine Bott-Silverman; Edward G Soltesz; Michael Z Y Tong; Shinya Unai; Ravi Nair; Jerry D Estep; Antonio L Perez Journal: ESC Heart Fail Date: 2020-05-19