This Article Full Text Full Text (PDF) Video Clips Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (11) Citing Articles via Google Scholar Google Scholar Articles by Chumnanvej, S. Articles by Melo, M. F. V. Search for Related Content PubMed PubMed Citation Articles by Chumnanvej, S. Articles by Melo, M. F. V. Related Collections Cardiovascular Heart Technology

---

CARDIOVASCULAR ANESTHESIA

Perioperative Echocardiographic Examination for Ventricular Assist Device Implantation

Siriluk Chumnanvej, MD^*, Malissa J. Wood, MD, Thomas E. MacGillivray, MD, and Marcos F. Vidal Melo, MD, PhD^*

From the *Department of Anesthesia and Critical Care; Division of Cardiology, Department of Medicine; and Cardiac Surgical Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.

Address correspondence and reprint requests to Marcos F. Vidal Melo MD, PhD, Department of Anesthesia and Critical Care, MA General Hospital, 55 Fruit St., Boston, MA 02114. Address e-mail to mvidalmelo{at}partners.org.

Ventricular assist devices (VADs) are systems for mechanical circulatory support of the patient with severe heart failure. Perioperative transesophageal echocardiography is a major component of patient management, and important for surgical and anesthetic decision making. In this review we present the rationale and available data for a comprehensive echocardiographic assessment of patients receiving a VAD. In addition to the standard examination, device-specific pre-, intra-, and postoperative considerations are essential to the echocardiographic evaluation. These include: (a) the pre-VAD insertion examination of the heart and large vessels to exclude significant aortic regurgitation, tricuspid regurgitation, mitral stenosis, patent foramen ovale, or other cardiac abnormality that could lead to right-to-left shunt after left VAD placement, intracardiac thrombi, ventricular scars, pulmonic regurgitation, pulmonary hypertension, pulmonary embolism, and atherosclerotic disease in the ascending aorta; and to assess right ventricular function; and (b) the post-VAD insertion examination of the device and reassessment of the heart and large vessels. The examination of the device aims to confirm completeness of device and heart deairing, cannulas alignment and patency, and competency of device valves using two-dimensional, and color, continuous and pulsed wave Doppler modalities. The goal for the heart examination after implantation should be to exclude aortic regurgitation, or an uncovered right-to-left shunt; and to assess right ventricular function, left ventricular unloading, and the effect of device settings on global heart function. The variety of VAD models with different basic and operation principles requires specific echocardiographic assessment targeted to the characteristics of the implanted device.

This article has been cited by other articles:

				S. V. Raman, T. Tran, O. P. Simonetti, and B. Sun Dynamic computed tomography to determine cardiac output in patients with left ventricular assist devices. J. Thorac. Cardiovasc. Surg., May 1, 2009; 137(5): 1213 - 1217. [Abstract] [Full Text] [PDF]

				N. Weitzel, F. Puskas, J. Cleveland, M. E. Levi, and T. Seres Left Ventricular Assist Device Outflow Cannula Obstruction by the Rare Environmental Fungus Myceliophthora thermophila Anesth. Analg., January 1, 2009; 108(1): 73 - 75. [Abstract] [Full Text] [PDF]

				W. J. Mauermann, K. H. Rehfeldt, and S. J. Park Transesophageal Echocardiography in a Patient in Hemodynamic Compromise After Jarvik 2000 TM Implantation: The Suckdown Effect Anesth. Analg., September 1, 2008; 107(3): 791 - 792. [Full Text] [PDF]

				J. Karhausen, M. Nowak, G. S. Couper, V. Formanek, V. Mirakaj, A. Locke, S. K. Shernan, and P. Rosenberger Right Ventricular Dissection Diagnosed on Transesophageal Echocardiography Anesth. Analg., February 1, 2008; 106(2): 412 - 414. [Full Text] [PDF]

				J. G. T. Augoustides Perioperative Echocardiographic Assessment of Left Ventricular Assist Device Implantation: Additional Causes of Inflow Cannula Obstruction Anesth. Analg., February 1, 2008; 106(2): 673 - 674. [Full Text] [PDF]

				S. Chumnanvej and M. F. V. Melo Perioperative Echocardiographic Assessment of Left Ventricular Assist Device Implantation: Additional Causes of Inflow Cannula Obstruction Anesth. Analg., February 1, 2008; 106(2): 674 - 674. [Full Text] [PDF]