Echocardiography is enormously useful in managing patients treated with left ventricular assist devices (LVADs), but its use in these patients is rarely addressed specifically. The combined functions of the LVAD and the native left and right ventricles create unique hemodynamic conditions, which must be considered in a comprehensive echocardiographic assessment of patients receiving LVADs. This chapter reviews the hemodynamic effects of LVADS, including the trade-off between pump output and flow pulsatility, left ventricular and left arterial unloading, and the effects of LVADs on the right heart. It then describes the preoperative use of echocardiography in patient selection, including how to assess right ventricular function, aortic and tricuspid regurgitation, and patent foramen ovale. It then considers the intraoperative assessment of the left heart, right ventricular function; tricuspid, aortic, and mitral regurgitation; the inflow and outflow cannulas, and pump flow and total cardiac output. Finally, the authors address the postoperative uses of echocardiography in surveillance, including assessing hypovolemia, postoperative tamponade, impeller thrombosis, and cannula kinking or obstruction, as well as how to optimize LVAD function and to troubleshoot LVAD malfunctions.
Computed Tomography–Estimated Right Ventricular Function and Exercise Capacity in Patients with Continuous-Flow Left Ventricular Assist Devices
