TY - JOUR
T1 - Flow pattern of outflow graft is useful for detecting pump thrombosis in a patient with left ventricular assist device
AU - Sato, Tasuku
AU - Fujino, Takeo
AU - Higo, Taiki
AU - ohtani, kisho
AU - Ken-Ichi, Hiasa
AU - Sakamoto, Takafumi
AU - Chishaki, Akiko
AU - Shiose, Akira
AU - Tsutsui, Hiroyuki
N1 - Funding Information:
From the 1Heart Center, Kyushu University Hospital, Fukuoka, Japan, 2Department of Health Sciences, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan, 3Department of Advanced Cardiopulmonary Failure, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan, 4Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan and 5Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan. This study is supported by Japan Intractable Diseases (Nanbyo) Research Foundation and JSPS KAKENHI Grant Number 18H03083. Address for correspondence: Takeo Fujino, MD, Department of Advanced Cardiopulmonary Failure, Kyushu University Graduate School of Medical Sciences, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. E-mail: tafujino@cardiol.med.kyushu-u.ac.jp Received for publication October 9, 2018. Revised and accepted December 18, 2018. Released in advance online on J-STAGE June 28, 2019. doi: 10.1536/ihj.18-600 All rights reserved by the International Heart Journal Association.
Funding Information:
Conflicts of interest: Takeo Fujino has an endowed chair from Medtronic Japan Co., Ltd., Social Medical Corporation Chiyukai, Abbott Medical Japan Co., Ltd. and Nipro Corporation. Hiroyuki Tsutsui received honoraria from Ot-suka, Takeda Pharmaceutical, Mitsubishi-Tanabe Pharma, Daiichi Sankyo, Nippon Boehringer, Bayer Yakuhin, Pfizer, Novartis Pharma, Ono Pharmaceutical, MSD, Tei-jin Pharma, Bristol-Myers Squibb and Astellas Pharma. Hiroyuki Tsutsui received manuscript fees from Medial View, Nippon Rinsho. Hiroyuki Tsutsui received research funding from Nippon Boehringer, Mitsubishi-Tanabe Pharma, Japan Tobacco, Daiichi Sankyo, IQVIA Services Japan, Takeda Pharmaceutical, Bayer Yakuhin, Sanofi, Ac-terion Pharmaceuticals Japan and MSD.
Publisher Copyright:
© 2019, International Heart Journal Association. All rights reserved.
PY - 2019
Y1 - 2019
N2 - Summary 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.
AB - Summary 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.
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U2 - 10.1536/ihj.18-600
DO - 10.1536/ihj.18-600
M3 - Article
C2 - 31257336
AN - SCOPUS:85070727531
SN - 1349-2365
VL - 60
SP - 994
EP - 997
JO - International Heart Journal
JF - International Heart Journal
IS - 4
ER -