Jimba Takahiro, Hatano Masaru, Fujiwara Takayuki, Akazawa Hiroshi, Watanabe Masafumi, Kinugawa Koichiro, Ono Minoru, Komuro Issei
Department of Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Advanced Medical Center for Heart Failure, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
J Cardiol Cases. 2023 Sep 16;29(1):7-10. doi: 10.1016/j.jccase.2023.08.017. eCollection 2024 Jan.
Right ventricular failure (RVF) is a serious complication after left ventricular assist device (LVAD) implantation. In this report, a case of RVF that developed over two years after LVAD implantation is presented. The patient was a 12-year-old male with dilated phase of hypertrophic cardiomyopathy. He had no risk factors for early or late-onset RVF. However, his right ventricular function worsened after he developed ventricular arrhythmia (VA), and right ventricular dysfunction became exacerbated with an increasing frequency of VAs. He also developed moderate aortic insufficiency (AI), which became severe. Two years after implantation, he was admitted for treatment of recurrent ventricular tachycardia and became inotropic-dependent during hospitalization. Finally, he underwent successful heart transplantation 2 years and 9 months after LVAD implantation. This case suggests that vicious cycle of RV dysfunction, recurrent VAs and severe AI could lead to RVF in patients without known risk factors for RVF, even long after LVAD implantation.
This report shows a progressive right ventricular failure (RVF) two years after left ventricular assist device (LVAD) implantation. Although the patient had no known risk factor, vicious circle of RV dysfunction, ventricular arrhythmias (VAs) and aortic insufficiency (AI) lead to RVF. Patients with LVAD as destination therapy will increase and require long-term LVAD management. We should recognize that these patients could develop RVF even years after LVAD implantation in association with VAs and AI.
右心室衰竭（RVF）是左心室辅助装置（LVAD）植入术后的一种严重并发症。在本报告中，介绍了1例LVAD植入术后两年发生的RVF病例。该患者为一名12岁男性，患有肥厚型心肌病扩张期。他没有早期或晚期发生RVF的危险因素。然而，在出现室性心律失常（VA）后，他的右心室功能恶化，并且随着VA频率增加，右心室功能障碍加剧。他还出现了中度主动脉瓣关闭不全（AI），并逐渐加重。植入后两年，他因复发性室性心动过速入院治疗，住院期间出现了对正性肌力药物的依赖。最终，在LVAD植入后2年9个月，他成功接受了心脏移植。该病例表明，在没有已知RVF危险因素的患者中，即使在LVAD植入后很长时间，右心室功能障碍、复发性VA和严重AI的恶性循环也可能导致RVF。
本报告展示了左心室辅助装置（LVAD）植入术后两年出现的进行性右心室衰竭（RVF）。尽管患者没有已知危险因素，但右心室功能障碍、室性心律失常（VAs）和主动脉瓣关闭不全（AI）的恶性循环导致了RVF。接受LVAD作为终末期治疗的患者将会增加，并且需要长期的LVAD管理。我们应该认识到，这些患者即使在LVAD植入数年之后，也可能因VAs和AI而发生RVF。
