scholarly journals A case of left ventricular free wall rupture after insertion of an IMPELLA® left ventricular assist device diagnosed by transesophageal echocardiography

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Akito Mizuno ◽  
Shuji Kawamoto ◽  
Shuji Uda ◽  
Kenichiro Tatsumi ◽  
Chikashi Takeda ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Left Ventricular Assist Device ◽  
Left Ventricular ◽  
Ventricular Wall ◽  
Free Wall ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
Ventricular Rupture ◽  
Left Ventricular Rupture

Abstract Background The IMPELLA® is a minimally invasive left ventricular assist device. We report a case in which transesophageal echocardiography (TEE) was useful in diagnosis of left ventricular rupture after IMPELLA® insertion. Case presentation A 75-year-old man presented to the emergency room with chest pain and underwent percutaneous coronary intervention for 100% stenosis of the left anterior descending branch #7. An IMPELLA® was inserted to stabilize the circulation, but hypotension persisted. Transthoracic echocardiography revealed increased pericardial effusion and suspicion of free wall left ventricular rupture, leading to emergency surgery. TEE revealed the IMPELLA® straying into the left ventricle apical wall and cardiac tamponade. Hemorrhage was observed from the thinning free wall and the tip of the IMPELLA® was palpable. The IMPELLA® was removed and the left ventricular wall was repaired. Conclusions The IMPELLA® requires implantation of the tip in the left ventricle, but it should be noted that a fragile ventricular wall can be easily perforated.

scholarly journals Primary Arterial Switch Operation for TGA/IVS and Regressed Left Ventricle: How and When to Use Left Ventricular Assist Device

2019 ◽  
Vol 11 (1) ◽  
pp. 97-100
Author(s):  
Dhananjay P. Malankar ◽  
Sachin Patil ◽  
Shivaji Mali ◽  
Shyam Dhake ◽  
Amit Mhatre ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Arterial Switch Operation ◽  
Left Ventricular ◽  
Assist Device ◽  
Ventricular Assist ◽  
Arterial Switch ◽  
Switch Operation ◽  
Left Ventricular Assist

Purpose: Numerous attempts have been made to extend the boundaries of arterial switch operation (ASO) in children presenting late with transposition of great arteries with intact ventricular septum (TGA/IVS) and regressed left ventricle (rLV). Many children tolerate the delayed ASO uneventfully, whereas others need mechanical circulatory support (MCS) to sustain the systemic circulation while the left ventricle undergoes retraining. Description: In this article, we describe six consecutive children with TGA/IVS and rLV who underwent primary ASO. Results: Three were managed medically, while three required MCS in the form of Centrimag left ventricular assist device (LVAD). All patients survived the operation and were discharged home in a stable condition. Conclusions: Primary ASO can be safely performed in children with TGA/IVS and rLV, provided the center has MCS options. Supporting the rLV with LVAD is feasible and can be achieved safely.

A Dynamical State Space Representation and Performance Analysis of a Feedback Controlled Rotary Left Ventricular Assist Device

2005 ◽  
Author(s):  
Antonio Ferreira ◽  
Shaohui Chen ◽  
David G. Galati ◽  
Marwan A. Simaan ◽  
James F. Antaki
Keyword(s):  
Left Ventricle ◽  
State Space ◽  
Left Ventricular Assist Device ◽  
Left Ventricular ◽  
Feedback Controller ◽  
Assist Device ◽  
Ventricular Assist ◽  
Pump Speed ◽  
Left Ventricular Assist ◽  
Rotary Type

The Left Ventricular Assist Device (LVAD) is a mechanical device that can assist an ailing natural heart in performing its functions. The latest generation of such devices is a rotary-type pump which is generally much smaller, lighter, and quieter than the conventional pulsatile-type pump. The rotary-type pumps are controlled by varying the rotor (impeller) speed. If the patient is in a health care facility, the pump speed can be adjusted manually by a trained clinician. However, an important challenge facing the increased use of these LVADs, is the desire to allow the patient to return home. The development of an appropriate patient adaptive feedback speed controller for the pump is therefore crucial to meet this challenge. In addition to being able to adapt to changes in the patient’s daily activities by automatically regulating the pump speed, the controller must also be able to prevent the occurrence of suction. In this paper we will discuss the theoretical and practical issues associated with the development of such a controller. As a flrst step, we will present a state-space mathematical model, based on a nonlinear equivalent circuit flow model, which represents the interaction of the pump with the left ventricle of the heart. The associated state space model is a 5-dimensional vector of time varying nonlinear difierential equations. The time variation occurs over 4 consecutive intervals representing the contraction, ejection, relaxation, and fllling phases of the left ventricle. The pump in the model is represented by a nonlinear equation which relates the pump rotational speed and the pump flow to the pressure difierence across the pump. Using this model, we will discuss a gradient based feedback controller which increases the pump speed to meet the patient requirements up to the point where suction may occur. At that point the controller will maintain a constant pump speed keeping the gradient of the minimum pump flow at zero. Simulation results using the model equipped with the feedback controller are presented for two cases representing two levels of patient activities. Performance of the controller for noisy measurements of pump blood flow is also investigated. Our results show that such a feedback controller performs very well and is fairly robust against measurements noise.

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