A 17-year-old 55 kg, 156 cm cachexic male was admitted with cough, abdominal distention,
and anasarca. He reported shortness of breath making it difficult to participate in
gym class. Examination demonstrated severe hepatomegaly, ascites, tachypnea, and pitting
lower extremity edema. Laboratory evaluation showed elevated brain natriuretic peptide,
reduced synthetic liver function, and preserved renal function. Echocardiogram and
cardiac catherization data was as shown in Table 1. He was started on Milrinone, diuretics and oxygen therapy. Repeat cardiac catheterization
with acute vasodilatory testing 1 month later was unchanged. A decision was made to
proceed with implantation of a HeartMate 3 left ventricular assist device (LVAD) utilizing
the technique described by Maeda et al.
1
Table 1Preoperative Echocardiography and Catheterization Results
| Echocardiogram | |||
|---|---|---|---|
| Function/Form | Size measurements | Doppler/Flow pattern | |
| Biventricular systolic function hyperdynamic Moderate pericardial effusion |
LV systolic diameter: 2.0 cm LV diastolic diameter: 3.4 cm LVPW systolic thickness: 1.0 cm Septal thickness: 0.67 cm Left Atrial systolic diameter: 6.2 cm |
Restrictive inflow pattern across mitral and tricuspid valves with mild insufficiencies. Diastolic flow reversal in inferior vena cava. |
|
| Cardiac catheterization | |||
| RVEDP | LVEDP | PAP | PVRi |
| 17 mm Hg | 20 mm Hg | Mean 48-50 mm Hg | 13 Wood units x m2 |
Abbreviations: LV, left ventricle; LVPW, Left ventricle posterior wall; RVEDP, Right
ventricle end-diastolic pressure; LVEDP, Left ventricle end-diastolic pressure; PAP,
Pulmonary arterial pressure; PVRi, indexed pulmonary vascular resistance.
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Reference
- An alternative approach by heartware ventricular assist device in hypertrophic cardiomyopathy.Annal Thoracic Surg. 2018; 106 (-11): e231-e232
Article info
Publication history
Published online: October 16, 2022
Footnotes
Informed Consent Statement: Consent was obtained for this case study.
IRB Statement: This paper was determined as “Not Research” by our IRB 7/5/2022.
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