Echocardiography and Continuous-Flow Left Ventricular Assist Devices

Cohen, David G.; Thomas, James D.; Freed, Benjamin H.; Rich, Jonathan D.; Sauer, Andrew J.

doi:10.1016/j.jchf.2015.03.003

Cited by 33 publications

(43 citation statements)

References 71 publications

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“…4 The "waterfall" artifact associated with the HeartWare (HeartWare International Inc., Framingham, MA) is an analogous example of this. 5 On meticulous retrospective review of the patient's 15 imaging studies performed since arrival at the authors' institution until upgrade to the CentriMag biventricular assist device, 1 of 11 TTE studies was found to have possible evidence of AR on hospital day 13, roughly 2 weeks after the Impella 5.0 implant. Significant color Doppler artifact induced by the Impella device likely obscured any existing AR jet (Fig 3).…”

Section: Discussionmentioning

confidence: 99%

Color Doppler Artifact Masking Iatrogenic Aortic Valve Injury Related to an Impella Device

Hong

Naseem

2019

Journal of Cardiothoracic and Vascular Anesthesia

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The Impella (Abiomed, Danvers, MA) is a minimally invasive transvalvular left ventricular assist device (LVAD) that effectively unloads the left ventricle (LV), especially in patients with ventricular arrhythmias in the setting of a venous-arterial extracorporeal membrane oxygenator (VA ECMO). 1,2 Utilization of the Impella device has increased significantly in the last few years for high-risk percutaneous coronary intervention and cardiogenic shock because of its relatively easy implantation in the catheterization lab and the operating room. Although rare, iatrogenic injury of the aortic valve (AV) can be caused by placement of the device across the AV.3 This can lead to aortic regurgitation (AR) with significant clinical consequences in the setting of cardiogenic shock. This AR can be challenging to diagnose echocardiographically because of the artifacts generated by the device when using color-flow Doppler. In this E-challenge, the authors emphasize the importance of recognizing these findings for accurate interpretation of the echocardiogram in the management of cardiogenic shock refractory to the Impella LVAD and the utility of transesophageal echocardiography (TEE).

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Section: Discussionmentioning

confidence: 99%

Color Doppler Artifact Masking Iatrogenic Aortic Valve Injury Related to an Impella Device

Hong

Naseem

2019

Journal of Cardiothoracic and Vascular Anesthesia

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“…It stands to reason that the commonly used semiquantitative assessment of AR may lead to underestimation of the true severity of AR, because it discounts that the regurgitant flow is not limited to diastole. Clear guidelines on the core applications of echocardiography in patients with cf-LVADs are lacking [21]. Recently, this knowledge gap has been somewhat reduced by recognition that simultaneous input from right-side heart catheterization and echocardiography provide better estimates of aortic valve regurgitant fraction than conventional echocardiographic measurements alone [22] in this patient population.…”

Section: Commentmentioning

confidence: 99%

De Novo Aortic Regurgitation After Continuous-Flow Left Ventricular Assist Device Implantation

Gašparović

Kopjar

Saeed

et al. 2017

The Annals of Thoracic Surgery

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Continuous-flow left ventricular assist devices (cf-LVAD) play an important role in the management of patients with advanced heart failure. De novo aortic regurgitation after cf-LVAD implantation may adversely impact device performance. We performed a systematic search of PubMed, SCOPUS, and Cochrane Library for articles reporting on the incidence and predictors of de novo aortic regurgitation among cf-LVAD recipients. Eight studies totaling 548 patients were identified in the meta-analysis. The pooled incidence of de novo AR across the analyzed studies was 37%. Factors influencing its development and progression are older age, persistent aortic valve closure, being female, and duration of cf-LVAD support.

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“…Related studies have identified that the blood pump inlet cannula influences the rate of cerebrovascular adverse events [10–12]. The blood pump inlet cannula is usually inserted into the left ventricle (LV) apex [13,14]. Javid Fatullayev’s study revealed that the positioning of the inflow cannula and the size of the pump pocket were shown to putatively contribute to thrombosis [15].…”

Section: Introductionmentioning

confidence: 99%

Effects of Cone-Shaped Bend Inlet Cannulas of an Axial Blood Pump on Thrombus Formation: An Experiment and Simulation Study

et al. 2017

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BackgroundCannula shape and connection style influence the risk of thrombus formation in the blood pump by varying the blood flow characteristics inside the pump. Inlet cannulas should be designed based on the need for anatomical fit and reducing the risk of thrombus generation in the blood pump. The effects on thrombus formation of the cone-shaped bend inlet cannulas of axial blood pumps should be studied.Material/MethodsThe cannulas were designed as cone-shaped, with 1 bent section connecting 2 straight sections. Both the silicone tube and novel cone-shaped cannula were simulated for comparison. The flow fields of a blood pump with inlet cannula were simulated by computational fluid dynamics (CFD) at flows of 2.0, 2.5, and 3.0 liters per minute (lpm), with pump rotational speeds of 7500, 8000, and 8500 rpm, respectively. Then, 6 two-dimensional (2D) particle image velocimetry (PIV) tests were conducted and the velocity distributions were analyzed.ResultsA low-velocity region was located inside the pump entrance when a soft silicone tube was used. At 8500 rpm and 3.0 lpm working condition, the minimum velocity inside the pump with cone-shaped cannulas was 2.5×10−1 m/s. The cone-shaped cannulas eliminated the low-velocity region inside the pump. Both CFD and PIV results showed that the low-velocity region did not spread to the entrance of the blood pump within the flow range from 2.0 lpm to 7.0 lpm.ConclusionsThe designed cone-shaped bent cannulas can eliminate the low-velocity region inside the blood pump and reduce the risk of thrombus formation in the blood pump.

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Echocardiography and Continuous-Flow Left Ventricular Assist Devices

Cited by 33 publications

References 71 publications

Color Doppler Artifact Masking Iatrogenic Aortic Valve Injury Related to an Impella Device

Color Doppler Artifact Masking Iatrogenic Aortic Valve Injury Related to an Impella Device

De Novo Aortic Regurgitation After Continuous-Flow Left Ventricular Assist Device Implantation

Effects of Cone-Shaped Bend Inlet Cannulas of an Axial Blood Pump on Thrombus Formation: An Experiment and Simulation Study

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