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LETTER TO THE EDITOR

Perioperative Echocardiographic Assessment of Left Ventricular Assist Device Implantation: Additional Causes of Inflow Cannula Obstruction

Department of Anesthesiology and Critical Care, (Cardiothoracic Section); Hospital of the University of Pennsylvania; Philadelphia, PA; yiandoc{at}hotmail.com

To the Editor:

The recent excellent review1 of the perioperative echocardiographic examination for ventricular assist device implantation details the published etiologies of inflow cannula obstruction such as hypovolemia, thrombus, and the interventricular septum. In the setting of a right ventricular assist device, the etiology of inflow cannula obstruction includes the interatrial septum and tricuspid valve.2 I would like to add the papillary muscle3 and the left atrial wall4 as described mechanical etiologies of inflow cannula obstruction in the setting of a left ventricular assist device. In both cases, the correct diagnosis was made echocardiographically. Subsequent prompt surgical intervention restored normal inflow cannula flow and normal ventricular assist device function.

Finally, diagnostic views of the inflow cannula orifice may be enhanced with epicardial scanning. This is especially important in the setting of unexplained low flows associated with ventricular assist device implantation.2

REFERENCES

1. Chumnanvej S, Wood MJ, MacGillivray TE, Melo MFV. Perioperative echocardiographic examination for ventricular assist device implantation. Anesth Analg 2007;105:583–601[Abstract/Free Full Text]
2. Augoustides J, Mancini DJ, Horak J, Pochettino A, Dupont F, Dowling RD. CASE 1-2003: The use of intraoperative echocardiography during insertion of ventricular assist devices. J Cardiothorac Vasc Anesth 2003;17:113–20[Web of Science][Medline]
3. Oda N, Kato TS, Niwaya K, Komamura K. Unusual cause of left ventricular assist device failure: pendulating mass in the cavity. Eur J Cardiothorac Surg 2007;32:533[Free Full Text]
4. Szymanski P, Religa G, Klisiewicz A, Baranska K, Hoffman P. Diagnosis of biventricular assist device inflow cannula obstruction. Echocardiography 2007;24:420–4[Web of Science][Medline]

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