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Anesth Analg 2008; 106:674-
© 2008 International Anesthesia Research Society
doi: 10.1213/ane.0b013e318160fdfe
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LETTER TO THE EDITOR

Section Editor:
Lawrence Saidman

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

Siriluk Chumnanvej, MD, and Marcos F. Vidal Melo, MD, PhD

Department of Anesthesiology; Phramongkutklao Hospital; Bangkok, Thailand (Chumnanvej) Cardiac Anesthesia Group; Department of Anesthesia and Critical Care; Massachusetts General Hospital and Harvard Medical School; Boston, MA; mvidalmelo{at}partners.org(Vidal Melo)

In Response:

Augoustides' comments1 on recently reported causes of inflow cannula obstruction reinforce a fundamental message of our article2; the field of ventricular assist devices is very dynamic and requires both a clear understanding of the device and components used, and solid anatomical and physiological knowledge. This, along with a critical mind, will allow the physician performing the echocardiographic assessment to go beyond the mechanical repetition of described prescriptions to actively and intelligently recognize new findings. In the specific examples cited, mobile cardiac structures, in the presence of a gradient of pressure and blood flow, can be shifted towards the lowest pressure and obstruct an inflow cannula. Finally, we join Dr. Augoustides in valuing epicardial scanning as an important intraoperative alternative, particularly in the case of difficult transesophageal images.

REFERENCES

  1. Augoustides JGT. Perioperative echocardiographic assessment of left ventricular assist device implantation: additional causes of inflow cannula obstruction. Anesth Analg 2008;106:673–4[Free Full Text]
  2. 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]




This Article
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2008 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press