Focused Review on Transthoracic Echocardiographic Assessment of Patients with Continuous Axial Left Ventricular Assist Devices

Figure 3

Severe functional mitral regurgitation. A patient presenting 17 months after LVAD implantation with failure to thrive and advanced right- and left-sided heart failure. (a) Hemodynamic right heart catheterization revealed markedly increased wedge and right atrial and ventricular pressures. Left atrial V wave (black arrow) reaching up to 70 mmHg was recorded suggesting significant functional mitral regurgitation. Echocardiographic examination during baseline RPM settings showed increased LV diameter (a), interventricular, interatrial septa shifted to the right, increased mitral annular diameter and tenting diameters (b), and severe functional mitral regurgitation. Left ventricular assist device speed was increased under echocardiographic guidance. Left ventricular middiameter decreased in size (e). Interventricular, interatrial septa shifted to the left and mitral annular and tenting diameters decreased in size (f). Functional mitral regurgitation severity decreased significantly (g). Right heart catheterization in the end of echocardiographic examination showed normal wedge, right ventricle, and right atrial pressures, and no V waves (h). Notably, cardiac output increased from 5.7 to 7.2 liters/minute after LVAD optimization.