Failing Systemic Right Ventricles With Persistent Pulmonary Hypertension: Candidates for Ventricular Assist Devices as Destination Therapy? Ophelie Loup,

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Presentation transcript:

Failing Systemic Right Ventricles With Persistent Pulmonary Hypertension: Candidates for Ventricular Assist Devices as Destination Therapy? Ophelie Loup, MD, Kerstin Wustmann, MD, Michele Vittorio Martinelli, MD, Markus Schwerzmann, MD, Paul Mohacsi, MD, Thierry Pierre Carrel, MD, Alexander Kadner, MD The Annals of Thoracic Surgery Volume 103, Issue 2, Pages e179-e181 (February 2017) DOI: 10.1016/j.athoracsur.2016.03.080 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Cardiac MRI. Right ventricular ejection fraction (RVEF) 23%, RV end-diastolic volume (RVEDV) 422 mL, RV end-diastolic index (RVEDi) 216 mL/m2, left ventricular ejection fraction (LVEF) 63%. (A–D) Thin a- and dyskinetic myocardium, consistent with an aneurysm (arrows) in the anterior wall of the severely impaired and dilated right ventricle. (A and B) Four-chamber view still frame of a steady-state free precession imaging/cine in end-diastole (A) and end-systole (B). (C and D) Short-axis view in end-diastole (C) and end-systole (D). (E and F) Short-axis view, late enhancement (thin arrows) in T1-weighted technique in anterior and inferior right ventricular wall and at the inferior insertion points, consistent with myocardial fibrosis. (LV = left ventricle; MRI = magnetic resonance imaging; RV = right ventricle.) The Annals of Thoracic Surgery 2017 103, e179-e181DOI: (10.1016/j.athoracsur.2016.03.080) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Transesophageal echocardiography—modified 5-chamber view. (A) Severely dilated systemic right ventricle (RV) preoperatively. (B) Inflow cannula (arrow) in the right ventricular anterior wall in end-diastole. (C) Inflow cannula without obstruction to flow in end-systole. The Annals of Thoracic Surgery 2017 103, e179-e181DOI: (10.1016/j.athoracsur.2016.03.080) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Volume rendering reconstruction images of computed tomographic scan of chest. (A) Anteroposterior view. Ventricular assist device (VAD) pump head (arrow) in anterior wall of systemic right ventricle; main pulmonary artery (PA) originating from left ventricle. (B) Lateral view. Pump head and inflow cannula (arrow) in right ventricle; anteriorly placed aorta (Ao) arising from right ventricle. The Annals of Thoracic Surgery 2017 103, e179-e181DOI: (10.1016/j.athoracsur.2016.03.080) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions