High Left Ventricular Assist Device Flows Resulting From Combined Native Aortic Valve and Outflow Valve Regurgitation
A 52-year-old woman with a left ventricular assist device (LVAD) and a history of hypertension was admitted with chest discomfort, dyspnea, and palpitations, which she had experienced for several days. On admission, it was noticed that her LVAD (Heart Mate I, Thoratec Inc) was in the auto mode and producing unusually high flows; output was 12 L/min and heart rate was 120 bpm. The LVAD had been implanted 17 months earlier as a bridging therapy for ischemic dilated cardiomyopathy. Five months before the current admission, the LVAD pump unit was replaced because of a mechanical dysfunction, although the original outflow valve was left in place.
An aortic angiogram revealed +1 aortic regurgitation of the native valve (Movie I), as well as to-and-fro flow through the outflow graft and the valve of the device (Movie II). The rotor of the device functioned properly (Movie III). The patient’s LVAD was put in fixed mode, and her symptoms promptly resolved.
Movies I, II, and III can be found in the online-only Data Supplement with this article at http://www.circulationaha.org.