Division of Cardiac Surgery, Department of Emergency and Organ Transplantation, Policlinico Hospital, University of Bari, Bari, Italy.
Braz J Cardiovasc Surg. 2022 May 2;37(2):145-152. doi: 10.21470/1678-9741-2021-0139.
Left ventricular assist devices are an established therapy for end-stage heart failure. Follow-up of these patients showed complications, such as thrombosis. Our objective was to evaluate the contribution of echocardiography - in association with HeartWare HVAD online logfiles reviews and lactate dehydrogenase titration - for diagnosis and treatment of thrombosis.
Seventeen episodes of thrombosis were diagnosed in 8/20 patients with HVAD. Diagnosis was made by trans-thoracic echocardiographic blood flow velocities, logfiles review of power consumption and pump flows, and titration of lactate dehydrogenase. Data were collected at baseline routine control (Group A), during thrombosis (Group B), after thrombolysis (Group C).
Thrombolysis was successful in all cases; one patient died of cerebral haemorrhage. Echocardiographic maximal blood flow velocity near the inflow cannula was 598±42 cm/sec (Group B), 379.41±21 cm/sec (Group C), and 378.24±28 cm/sec (Group A) (P<0.00001). In eight (47%) cases, thrombi were visualized in the left ventricle by three-dimensional modality. Logfiles recordings of blood flows were 9.52±0.9 L/min (Group B), 4.02±0.4 L/min (Group C), and 4.04±0.4 L/min (Group A) (P<00001). Power consumption was 5.01±0.7 W (Group B), 3.45±0.2 W (Group C), and 3.46±0.2 W (Group A) (P<0.00001). Lactate dehydrogenase was 756±54 IU (Group B), 234±22 IU (Group A), and 257±36 IU (Group C) (P<0.00001).
Echocardiography of increased maximal velocity near the inflow cannula is a sign of HVAD obstruction. Logfile reviews provide a clear picture of HVAD obstruction. Combination of echocardiographic data and review of logfiles detects signs of left ventricular assist devices thrombosis leading to a successful treatment.
左心室辅助装置是治疗终末期心力衰竭的一种成熟疗法。这些患者的随访显示存在血栓等并发症。我们的目的是评估超声心动图——结合 HeartWare HVAD 在线日志文件回顾和乳酸脱氢酶滴定——在诊断和治疗血栓中的作用。
在 20 名 HVAD 患者中，有 17 例血栓形成被诊断。诊断通过经胸超声心动图血流速度、功率消耗和泵流量的日志文件回顾以及乳酸脱氢酶滴定进行。数据在基线常规控制时（A 组）、血栓形成时（B 组）和溶栓后（C 组）收集。
所有病例溶栓均成功，1 例患者因脑出血死亡。近流入管的超声心动图最大血流速度为 598±42cm/sec（B 组）、379.41±21cm/sec（C 组）和 378.24±28cm/sec（A 组）（P<0.00001）。在 8 例（47%）病例中，三维模式下可见左心室血栓。血流的日志文件记录为 9.52±0.9L/min（B 组）、4.02±0.4L/min（C 组）和 4.04±0.4L/min（A 组）（P<00001）。功率消耗为 5.01±0.7W（B 组）、3.45±0.2W（C 组）和 3.46±0.2W（A 组）（P<0.00001）。乳酸脱氢酶为 756±54IU（B 组）、234±22IU（A 组）和 257±36IU（C 组）（P<0.00001）。
近流入管处最大血流速度增加是 HVAD 梗阻的标志。日志文件回顾提供了 HVAD 梗阻的清晰图像。超声心动图数据和日志文件回顾的结合检测到左心室辅助装置血栓形成的迹象，从而导致成功治疗。
