ECHO 2013 / Echocardiography in Advanced Heart Failure Mechanical Support
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Role of echo in mechanical support devices
•Diagnosis, suitability, selection
–LVAD or BiVAD ?
•Function of valves pre-implant (aortic insufficiency)
•LV thrombus, PFO, PHTN
•Function of device
–Cardiac volumes, cannula positions
•Function of LV, RV
•Assessing complications
–hematoma, intracardiac thrombus, infections, failure of valves in the conduits
•Adjusting flow rates
– How does LV respond as LVAD flows are reduced?
Pre-implant echo assessent
Echo finding |
implications |
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|
Marked RV dysfunction |
Reduced (inadequate) LV and pump |
|
preload, low pump flow |
|
|
Fixed PHTN |
Reduced LV and pump preload |
|
|
Severe TR |
Worse RV function post-implant |
|
|
PFO (or ASD) |
Progressive R-L shunt and hypoxia |
|
|
> Mild AI |
Influences LVAD efficiency (fix) |
|
|
LV apical thrombus |
Influences inflow cannula placement |
|
|
Asc aortic aneurysm |
Influences outflow cannula placement |
|
|
Severe HF in 68 yo M 12 years after tissue AVR / CABG. Should we
place an LVAD ?
Imaging assist devices
•Post implant Left heart
–Outflow and inflow
•LV apex/LA appendage, Ascending aorta, etc
•Doppler
–Flow patterns
•Pericardial effusions
–Aortic valve
•Is it opening ? Should it be opening ?
–Relative volumes
•Septal position
•24 yo with 5 weeks of progressive heart failure which began after delivery of healthy child
–Class IV on maximum medical therapy
–No coronary artery disease or other known cause for cardiomyopathy on extensive w/u
•Referred to MGH with post-partum cardiomyopathy for consideration of heart transplant
Ventricular function upon arrival at
MGH
TR and MR upon transfer
Severe TR |
Severe MR |
|
s/p TV annuloplasty and LVAD
(heartmate II LVAS) TEE at post-op day 2
Flow from LV into inflow conduit
CW Doppler
