[Intraoperative management of simultaneous biventricular assist device placement in a patient with post-myocarditis dilated cardiomyopathy].

We experienced intra-operative management of a patient with post-myocarditis cardiomyopathy who underwent simultaneous biventricular assist device (BiVAD) placement. Although the BiVAD is considered to replace biventricular pump function, significant discrepancy between the flow of the right ventricular assist device (RVAD) and the left ventricular assist device (LVAD) caused difficulty in post-bypass circulatory management in our case. We administered a vasodilator to decrease pulmonary vascular resistance (PVR) and regurgitant fraction of RVAD flow into right ventricle. Inhaled nitric oxide may provide a favorable decrease of PVR. With BiVAD, comprehensive management including the optimization of systemic blood volume, systemic vascular resistance, PVR and native heart function is essential. Transesophageal echocardiography is useful in intraoperative diagnosis and a guide for decision-making in circulatory management.