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Assessment of Ventricular Assist Device (VAD) Function and Detection of Complications using Transoesophageal Echocardiography (TOE)
Abstracts
S19
37 ASSESSMENT OF VENTRICULAR ASSIST DEVICE (VAD) FUNCTION AND DETECTION OF COMPLICATIONS USING TRANSOESOPHAGEAL ECHOCARDIOGRAPHY (TOE)
38 ASSESSMENT OF PARAVALVULAR PROSTHETIC MITRAL REGURGITATION WITH MULTI-MODALITY IMAGING: PROCEDURAL AND FOLLOW-UP RESULTS
D. Platts, C. Hamilton Craig, B. Bell, T. Boga, J. Bancroft, D. Burstow
Akshay Mishra, Richard Slaughter, Christian HamiltonCraig, Tau Boga, Greg Scalia, Darryl Burstow, Darren Walters
The Prince of Charles Hospital, Rode Rd, Brisbane, Queensland, Australia
The Prince Charles Hospital, Queensland, Australia
Background: Ventricular assist devices are utilised in selected cases to treat severe heart failure. However, their use can be limited by complications such as thrombosis, infection and device failure. Cardiac and VAD structure, function and resultant haemodynamics can be difficult to assess in these patients, particularly using transthoracic echocardiography (TTE). TOE is uniquely positioned to assess these parameters and detect such complications. Method: We retrospectively evaluated all patients at our institution who had a VAD inserted in the last 3 years. TOE indications and significant findings were compiled. Key points noted were the detection of complications and how TOE findings influenced diagnosis and management. Results: 101 TOE and 105 TTE studies were performed in 15 patients (M = 9, F = 6, mean age 45.2 years) who had a VAD inserted between 2006 and 2009 (BiVAD = 10, LVAD only = 5). Thoratec = 9, Abiomed = 4, VentrAssist = 2. Reason for VAD insertion: CAD = 5, cardiomyopathy = 4, acute myocarditis = 4, other = 2. Indications for TOE include haemodynamic instability (40), wind-down protocol (10), cannula flow/position issues (10), possible infection (9), embolic phenomena (5). Number of TOE showing VAD cannula/cardiac thrombosis = 8, VAD infection = 4, VAD cannula obstruction or malposition = 17, pericardial haematoma = 15, detection of intra-cardiac shunt = 3, guide to VAD insertion = 14, guide during VAD winddown = 10, used to optimise VAD settings/flows = 2. Conclusion: TTE can be of limited use in VAD assessment due to reduced acoustic windows in these patients and lower spatial resolution. TOE is uniquely placed to detect complications which arise and provide data on cardiac and VAD structure, function and haemodynamics, which is of importance in management of these complex patients.
Background: Paravalvular mitral regurgitation is a complication of mitral valve replacement surgery with increased morbidity and mortality. Treatment of these is usually with a repeat surgical procedure however in patients with a high surgical risk or those with a personal preference for percutaneous intervention, device closure may be offered. Methods: We retrospectively reviewed our institutional data on percutaneous mitral paravalvular leak closures over the last 2 years. Procedural, in hospital and follow-up results were analysed. Results: A total of six percutaneous paravalvular leak closures were performed over 2 years. Percutaneous intervention was the chosen modality in preference to surgery due to high surgical risk in three patients, complications during previous surgery in two and patient preference in one. The patients were evaluated with TTE and trans esophageal echocardiography (TEE) in all cases. Live three-dimensional TEE was an additional modality used in five cases. Patients had preprocedure cardiac magnetic resonance imaging (CMRI) in four cases. There were no deaths or MACE during the procedure. Implantation of the device was technically successful in four out of six patients. All patients remained well without MACE at a mean follow-up of 7 months, range 1–16 months. Conclusions: Transcatheter percutaneous paravalvular leak closure is a technically demanding but feasible procedure. Cardiac imaging using TEE, 3DTEE and CMRI allow for accurate evaluation of paravalvular geometry, and aid intra-procedural guidance to achieve the best possible results.
doi:10.1016/j.hlc.2009.05.039
39 ASSESSMENT OF THE VARIABILITY OF THE CORONARY SINUS BY CARDIAC COMPUTED TOMOGRAPHY
doi:10.1016/j.hlc.2009.05.040
R. Poulter, M. Dooris, J.F. Younger Royal Brisbane & Women’s Hospital, Brisbane, Australia Introduction: Reconstruction of computed tomography (CT) images in the manner for optimal coronary artery imaging may not be ideal for venous imaging due to changes in venous luminal diameter during the cardiac cycle. The nature and magnitude of these changes and the factors influencing them have not been established.
ABSTRACTS
Heart, Lung and Circulation 2009;18S:S1–S286
S19
37 ASSESSMENT OF VENTRICULAR ASSIST DEVICE (VAD) FUNCTION AND DETECTION OF COMPLICATIONS USING TRANSOESOPHAGEAL ECHOCARDIOGRAPHY (TOE)
38 ASSESSMENT OF PARAVALVULAR PROSTHETIC MITRAL REGURGITATION WITH MULTI-MODALITY IMAGING: PROCEDURAL AND FOLLOW-UP RESULTS
D. Platts, C. Hamilton Craig, B. Bell, T. Boga, J. Bancroft, D. Burstow
Akshay Mishra, Richard Slaughter, Christian HamiltonCraig, Tau Boga, Greg Scalia, Darryl Burstow, Darren Walters
The Prince of Charles Hospital, Rode Rd, Brisbane, Queensland, Australia
The Prince Charles Hospital, Queensland, Australia
Background: Ventricular assist devices are utilised in selected cases to treat severe heart failure. However, their use can be limited by complications such as thrombosis, infection and device failure. Cardiac and VAD structure, function and resultant haemodynamics can be difficult to assess in these patients, particularly using transthoracic echocardiography (TTE). TOE is uniquely positioned to assess these parameters and detect such complications. Method: We retrospectively evaluated all patients at our institution who had a VAD inserted in the last 3 years. TOE indications and significant findings were compiled. Key points noted were the detection of complications and how TOE findings influenced diagnosis and management. Results: 101 TOE and 105 TTE studies were performed in 15 patients (M = 9, F = 6, mean age 45.2 years) who had a VAD inserted between 2006 and 2009 (BiVAD = 10, LVAD only = 5). Thoratec = 9, Abiomed = 4, VentrAssist = 2. Reason for VAD insertion: CAD = 5, cardiomyopathy = 4, acute myocarditis = 4, other = 2. Indications for TOE include haemodynamic instability (40), wind-down protocol (10), cannula flow/position issues (10), possible infection (9), embolic phenomena (5). Number of TOE showing VAD cannula/cardiac thrombosis = 8, VAD infection = 4, VAD cannula obstruction or malposition = 17, pericardial haematoma = 15, detection of intra-cardiac shunt = 3, guide to VAD insertion = 14, guide during VAD winddown = 10, used to optimise VAD settings/flows = 2. Conclusion: TTE can be of limited use in VAD assessment due to reduced acoustic windows in these patients and lower spatial resolution. TOE is uniquely placed to detect complications which arise and provide data on cardiac and VAD structure, function and haemodynamics, which is of importance in management of these complex patients.
Background: Paravalvular mitral regurgitation is a complication of mitral valve replacement surgery with increased morbidity and mortality. Treatment of these is usually with a repeat surgical procedure however in patients with a high surgical risk or those with a personal preference for percutaneous intervention, device closure may be offered. Methods: We retrospectively reviewed our institutional data on percutaneous mitral paravalvular leak closures over the last 2 years. Procedural, in hospital and follow-up results were analysed. Results: A total of six percutaneous paravalvular leak closures were performed over 2 years. Percutaneous intervention was the chosen modality in preference to surgery due to high surgical risk in three patients, complications during previous surgery in two and patient preference in one. The patients were evaluated with TTE and trans esophageal echocardiography (TEE) in all cases. Live three-dimensional TEE was an additional modality used in five cases. Patients had preprocedure cardiac magnetic resonance imaging (CMRI) in four cases. There were no deaths or MACE during the procedure. Implantation of the device was technically successful in four out of six patients. All patients remained well without MACE at a mean follow-up of 7 months, range 1–16 months. Conclusions: Transcatheter percutaneous paravalvular leak closure is a technically demanding but feasible procedure. Cardiac imaging using TEE, 3DTEE and CMRI allow for accurate evaluation of paravalvular geometry, and aid intra-procedural guidance to achieve the best possible results.
doi:10.1016/j.hlc.2009.05.039
39 ASSESSMENT OF THE VARIABILITY OF THE CORONARY SINUS BY CARDIAC COMPUTED TOMOGRAPHY
doi:10.1016/j.hlc.2009.05.040
R. Poulter, M. Dooris, J.F. Younger Royal Brisbane & Women’s Hospital, Brisbane, Australia Introduction: Reconstruction of computed tomography (CT) images in the manner for optimal coronary artery imaging may not be ideal for venous imaging due to changes in venous luminal diameter during the cardiac cycle. The nature and magnitude of these changes and the factors influencing them have not been established.
ABSTRACTS
Heart, Lung and Circulation 2009;18S:S1–S286