Extracorporeal membrane oxygenation‐assisted emergency percutaneous treatment of left ventricular assist device graft occlusion
Abstract End‐stage heart failure is more often treated with Implantable left ventricular assist device (LVAD), even if the prolonged use may increase the risk of complications. In this case, a 51‐year‐old male patient presented to our emergency department showing acute heart failure signs and sympto...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-04-01
|
| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.13205 |
| _version_ | 1818410704911204352 |
|---|---|
| author | Rocco Edoardo Stio Andrea Montalto Mariano Feccia Alfredo Intorcia Vitaliano Buffa Vincenzo Cesario Giulia Petroni Francesco De Felice Francesco Musumeci |
| author_facet | Rocco Edoardo Stio Andrea Montalto Mariano Feccia Alfredo Intorcia Vitaliano Buffa Vincenzo Cesario Giulia Petroni Francesco De Felice Francesco Musumeci |
| author_sort | Rocco Edoardo Stio |
| collection | DOAJ |
| description | Abstract End‐stage heart failure is more often treated with Implantable left ventricular assist device (LVAD), even if the prolonged use may increase the risk of complications. In this case, a 51‐year‐old male patient presented to our emergency department showing acute heart failure signs and symptoms and a dramatic reduction of LVAD flow. Laboratory tests ruled out significant haemolysis, usually associated with pump thrombosis. The echocardiogram and the computed tomography were not able to clarify the correct diagnosis. We immediately placed a veno‐arterial extracorporeal membrane oxygenation, followed by a selective retrograde angiography of the pump. The images showed stenosis of the LVAD‐outflow graft, suggesting a twist. Through a hand‐made J‐tip guidewire, we performed multiple dilatations of the occlusion using peripheral balloons. Finally, we implanted an aortic coarctation covered‐stent, re‐establishing an adequate cardiac output to the patient. Our case indicates that catheter‐based approach in extracorporeal membrane oxygenation assistance provides an important therapeutic alternative to treat outflow graft stenosis, especially in the case of acutely unstable patient. |
| first_indexed | 2024-12-14T10:19:45Z |
| format | Article |
| id | doaj.art-f7f1e2ebe872479f923e4dc0d27dac66 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-12-14T10:19:45Z |
| publishDate | 2021-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-f7f1e2ebe872479f923e4dc0d27dac662022-12-21T23:06:37ZengWileyESC Heart Failure2055-58222021-04-01821627163010.1002/ehf2.13205Extracorporeal membrane oxygenation‐assisted emergency percutaneous treatment of left ventricular assist device graft occlusionRocco Edoardo Stio0Andrea Montalto1Mariano Feccia2Alfredo Intorcia3Vitaliano Buffa4Vincenzo Cesario5Giulia Petroni6Francesco De Felice7Francesco Musumeci8Division of Interventional Cardiology, Department of Heart and Vessels San Camillo Forlanini Hospital Circonvallazione Gianicolense 87 Rome 00152 ItalyDepartment of Heart and Vessels, Cardiac Surgery Unit and Heart Transplantation Center San Camillo Forlanini Hospital Rome ItalyDepartment of Heart and Vessels, Cardiac Surgery Unit and Heart Transplantation Center San Camillo Forlanini Hospital Rome ItalyDivision of Interventional Cardiology, Department of Heart and Vessels San Camillo Forlanini Hospital Circonvallazione Gianicolense 87 Rome 00152 ItalyDivision of Radiology San Camillo Forlanini Hospital Rome ItalyDivision of Interventional Cardiology, Department of Heart and Vessels San Camillo Forlanini Hospital Circonvallazione Gianicolense 87 Rome 00152 ItalyDepartment of Legal and Forensic Medicine, Social Security and Forensic Toxicology University of Rome Tor Vergata Rome ItalyDivision of Interventional Cardiology, Department of Heart and Vessels San Camillo Forlanini Hospital Circonvallazione Gianicolense 87 Rome 00152 ItalyDepartment of Heart and Vessels, Cardiac Surgery Unit and Heart Transplantation Center San Camillo Forlanini Hospital Rome ItalyAbstract End‐stage heart failure is more often treated with Implantable left ventricular assist device (LVAD), even if the prolonged use may increase the risk of complications. In this case, a 51‐year‐old male patient presented to our emergency department showing acute heart failure signs and symptoms and a dramatic reduction of LVAD flow. Laboratory tests ruled out significant haemolysis, usually associated with pump thrombosis. The echocardiogram and the computed tomography were not able to clarify the correct diagnosis. We immediately placed a veno‐arterial extracorporeal membrane oxygenation, followed by a selective retrograde angiography of the pump. The images showed stenosis of the LVAD‐outflow graft, suggesting a twist. Through a hand‐made J‐tip guidewire, we performed multiple dilatations of the occlusion using peripheral balloons. Finally, we implanted an aortic coarctation covered‐stent, re‐establishing an adequate cardiac output to the patient. Our case indicates that catheter‐based approach in extracorporeal membrane oxygenation assistance provides an important therapeutic alternative to treat outflow graft stenosis, especially in the case of acutely unstable patient.https://doi.org/10.1002/ehf2.13205Heart failureHeart transplantationVentricular assist deviceOutflow graft obstructionExtracorporeal membrane oxygenation |
| spellingShingle | Rocco Edoardo Stio Andrea Montalto Mariano Feccia Alfredo Intorcia Vitaliano Buffa Vincenzo Cesario Giulia Petroni Francesco De Felice Francesco Musumeci Extracorporeal membrane oxygenation‐assisted emergency percutaneous treatment of left ventricular assist device graft occlusion ESC Heart Failure Heart failure Heart transplantation Ventricular assist device Outflow graft obstruction Extracorporeal membrane oxygenation |
| title | Extracorporeal membrane oxygenation‐assisted emergency percutaneous treatment of left ventricular assist device graft occlusion |
| title_full | Extracorporeal membrane oxygenation‐assisted emergency percutaneous treatment of left ventricular assist device graft occlusion |
| title_fullStr | Extracorporeal membrane oxygenation‐assisted emergency percutaneous treatment of left ventricular assist device graft occlusion |
| title_full_unstemmed | Extracorporeal membrane oxygenation‐assisted emergency percutaneous treatment of left ventricular assist device graft occlusion |
| title_short | Extracorporeal membrane oxygenation‐assisted emergency percutaneous treatment of left ventricular assist device graft occlusion |
| title_sort | extracorporeal membrane oxygenation assisted emergency percutaneous treatment of left ventricular assist device graft occlusion |
| topic | Heart failure Heart transplantation Ventricular assist device Outflow graft obstruction Extracorporeal membrane oxygenation |
| url | https://doi.org/10.1002/ehf2.13205 |
| work_keys_str_mv | AT roccoedoardostio extracorporealmembraneoxygenationassistedemergencypercutaneoustreatmentofleftventricularassistdevicegraftocclusion AT andreamontalto extracorporealmembraneoxygenationassistedemergencypercutaneoustreatmentofleftventricularassistdevicegraftocclusion AT marianofeccia extracorporealmembraneoxygenationassistedemergencypercutaneoustreatmentofleftventricularassistdevicegraftocclusion AT alfredointorcia extracorporealmembraneoxygenationassistedemergencypercutaneoustreatmentofleftventricularassistdevicegraftocclusion AT vitalianobuffa extracorporealmembraneoxygenationassistedemergencypercutaneoustreatmentofleftventricularassistdevicegraftocclusion AT vincenzocesario extracorporealmembraneoxygenationassistedemergencypercutaneoustreatmentofleftventricularassistdevicegraftocclusion AT giuliapetroni extracorporealmembraneoxygenationassistedemergencypercutaneoustreatmentofleftventricularassistdevicegraftocclusion AT francescodefelice extracorporealmembraneoxygenationassistedemergencypercutaneoustreatmentofleftventricularassistdevicegraftocclusion AT francescomusumeci extracorporealmembraneoxygenationassistedemergencypercutaneoustreatmentofleftventricularassistdevicegraftocclusion |