Stephen Westaby, FRCS, Xu Y. Jin, MD, Takahiro Katsumata, MD, David P

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Mechanical Support in Dilated Cardiomyopathy: Signs of Early Left Ventricular Recovery Stephen Westaby, FRCS, Xu Y. Jin, MD, Takahiro Katsumata, MD, David P. Taggart, MD(Hons), Andrew J.S. Coats, FRCP, O.H. Frazier, MD The Annals of Thoracic Surgery Volume 64, Issue 5, Pages 1303-1308 (November 1997) DOI: 10.1016/S0003-4975(97)00910-7 Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Serial recordings of the carotid artery pulse with simultaneous electrocardiography (ECG) and phonocardiography (PCG) were obtained from 1 day before to 8 weeks after the implantation of the TCI left ventricular assist device (LVAD). Note that a significant influence from respiration was imposed on the amplitude of the arterial pulse before the implantation of the LVAD. Four weeks after implantation of the LVAD the arterial pulse entirely follows the output of the LVAD (as indicated by the phonocardiogram), with no input from the native left ventricle. By 6 weeks the arterial pulse remains dominated by the LVAD; however, there are small pulse waves occurring between the LVAD output. At 8 weeks, in addition to the dominant pulse wave from the LVAD, there is significant output from the native left ventricle with a consistent relationship to the electrocardiogram. The Annals of Thoracic Surgery 1997 64, 1303-1308DOI: (10.1016/S0003-4975(97)00910-7) Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Serial recordings of mitral flow velocity obtained by Doppler echocardiography were made from 1 day before to 8 weeks after implantation of the left ventricular assist device (LVAD). Note that before implantation there is a single spiked summation wave of filling velocity (less than 200 ms), which indicates a very restrictive filling pattern. At 8 weeks the filling velocity after atrial systole has become dominant and the filling time has lengthened to 600 ms. This suggests a greatly improved left ventricular filling profile. (ECG=electrocardiography; PCG=phonocardiography.) The Annals of Thoracic Surgery 1997 64, 1303-1308DOI: (10.1016/S0003-4975(97)00910-7) Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Serial recordings of left ventricular minor axis dimension obtained by M-mode echocardiography from 1 day before to 8 weeks after implantation of the left ventricular assist device (LVAD). Note that before implantation there was a very dilated and hypokinetic left ventricle. Four weeks after implantation the end-diastolic dimension has decreased from the original 8.5cm to 5.5cm and has remained at this level at 8 weeks. Meanwhile the posterior wall inward motion and the reversal of septal wall motion (after the electrocardiogram) progressively increased from 4 weeks to 8 weeks. This suggests an improvement in native left ventricular systolic function. (ECG=electrocardiography; PCG=phonocardio-graphy.) The Annals of Thoracic Surgery 1997 64, 1303-1308DOI: (10.1016/S0003-4975(97)00910-7) Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 With the left ventricular assist device (LVAD) switched off at 8 weeks after implantation, there was a significant increase in the left ventricular outflow tract flow velocity with well-sustained left ventricular cavity dimensions, wall motion pattern, and ventricular filling pattern. The arterial pulse and pulmonary flow velocity are well maintained. (ECG=electrocardiography; LV=left ventricular; PCG=phonocardiography.) The Annals of Thoracic Surgery 1997 64, 1303-1308DOI: (10.1016/S0003-4975(97)00910-7) Copyright © 1997 The Society of Thoracic Surgeons Terms and Conditions