RSS-Feed abonnieren
DOI: 10.1055/s-0042-1746427
Clinical Course During LVAD Support in a Patient with Ventricular Pseudoaneurysm
I congratulate Radakovic and colleagues, who successfully implanted durable left ventricular assist device (LVAD) in a patient with ventricular pseudo-aneurysm due to acute myocardial infarction.[1] They reported that the patient were managed for 19 months without any device-related complications. Several concerns have been raised.
One of the primary concerns following the reconstruction of ruptured left ventricular free wall is recurrent rupture. Management of LVAD requires sufficient anti-coagulation therapy to prevent thrombus complications.[2] Did the authors pay special attention to the anti-coagulation therapy? What was the target international normalized ratio of prothrombin time?
The patient had severe mitral regurgitation prior to LVAD implantation.[1] In general, continuous mechanical unloading and reverse remodeling improve functional mitral regurgitation during LVAD support.[3] The patient received left ventricular reconstruction, and might have less chance to achieve reverse remodeling. Did mitral regurgitation improve following LVAD implantation?
Broad acute myocardial infarction often involves right ventricular failure. In general, right ventricular failure further progresses following LVAD implantation due to incremental preload on the right heart and geometrical change in the right heart.[4] Did the authors have clinical data indicating right ventricular failure, including pulmonary artery pulsatility index and tricuspid annular plane systolic excursion?
#
Conflict of Interest
None declared.
-
References
- 1 Radakovic D, Penov K, Güder G, Aleksic I. Left ventricular assist device implantation in a patient with ventricular pseudoaneurysm. Thorac Cardiovasc Surg Rep 2022; 11 (01) e11-e13
- 2 Suarez J, Patel CB, Felker GM, Becker R, Hernandez AF, Rogers JG. Mechanisms of bleeding and approach to patients with axial-flow left ventricular assist devices. Circ Heart Fail 2011; 4 (06) 779-784
- 3 Kanwar MK, Rajagopal K, Itoh A. et al. Impact of left ventricular assist device implantation on mitral regurgitation: an analysis from the MOMENTUM 3 trial. J Heart Lung Transplant 2020; 39 (06) 529-537
- 4 Lampert BC, Teuteberg JJ. Right ventricular failure after left ventricular assist devices. J Heart Lung Transplant 2015; 34 (09) 1123-1130
Address for correspondence
Publikationsverlauf
Eingereicht: 08. Februar 2022
Angenommen: 21. Februar 2022
Artikel online veröffentlicht:
04. Juli 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Radakovic D, Penov K, Güder G, Aleksic I. Left ventricular assist device implantation in a patient with ventricular pseudoaneurysm. Thorac Cardiovasc Surg Rep 2022; 11 (01) e11-e13
- 2 Suarez J, Patel CB, Felker GM, Becker R, Hernandez AF, Rogers JG. Mechanisms of bleeding and approach to patients with axial-flow left ventricular assist devices. Circ Heart Fail 2011; 4 (06) 779-784
- 3 Kanwar MK, Rajagopal K, Itoh A. et al. Impact of left ventricular assist device implantation on mitral regurgitation: an analysis from the MOMENTUM 3 trial. J Heart Lung Transplant 2020; 39 (06) 529-537
- 4 Lampert BC, Teuteberg JJ. Right ventricular failure after left ventricular assist devices. J Heart Lung Transplant 2015; 34 (09) 1123-1130