Christopher N. Pierce

Successive circulatory support stages: a triple bridge to recovery from fulminant myocarditis.

Fulminant myocarditis with rapid onset of symptoms and hemodynamic compromise is a rare indication for mechanical support. Because of the potentially reversible nature of this illness, advanced mechanical circulatory support is warranted to achieve recovery or as a bridge to transplantation. Circulatory device options currently available allow for a phased implementation of support modalities in a manner that reduces costs and patient risk. We present a patient with fulminant myocarditis where extracorporeal membrane oxygenation (ECMO) support escalated to short-term Levitronix CentriMag (Levitronix, Waltham, MA) biventricular assist devices (BiVADs). These in turn were exchanged, without major surgery, to long-term paracorporeal VADs (Thoratec, Pleasanton, CA). After rehabilitation and nearly total recovery, the patient was weaned from mechanical circulatory support after 104 cumulative days.

Parallel Application of Extracorporeal Membrane Oxygenation and the CardioWest Total Artificial Heart as a Bridge to Transplant

Circulatory assist devices are an increasingly common method of treating patients with refractory cardiogenic shock. We describe a patient who was a heart transplant candidate with biventricular failure who underwent CardioWest total artificial heart-temporary (SynCardia Inc, Tucson, AZ) implantation with extracorporeal membrane oxygenation to manage the patients subsequent respiratory failure. After respiratory and hemodynamic stabilization, the CardioWest total artificial heart-temporary served as a successful 62-day bridge-to-heart transplantation.

An unusual presentation of left ventricular assist device thrombus

A 41-year-old man with non-ischaemic dilated cardiomyopathy and morbid obesity was hospitalized with shortness of breath, abdominal pain, and haematochezia. At the age of 39 years, he underwent a left ventricular assist device (LVAD) placement (HeartMate II; Thoratec Corporation, Pleasanton, CA) for destination therapy and tricuspid valve annuloplasty. Initial evaluation revealed ischaemic colitis, elevated left heart filling pressures, and severe haemolysis. LVAD readings were not definitive but suggested a thrombus. Colour flow Doppler transesophageal echocardiography (TEE) demonstrated a normal flow in the left ventricular inflow ( Panel A ; see Supplementary data online, Movie S1 ) and outflow …

Transoesophageal echocardiographic Doppler colour flow patterns of a normally functioning third-generation centrifugal left ventricular assist device

A 75-year-old man with history of atrial fibrillation, ischaemic cardiomyopathy, and biventricular pacemaker implantable cardioverter-defibrillator presented with automated implantable cardioverter-defibrillator (AICD) discharge and worsened exertional dyspnoea and lower extremity oedema. Six months previously, he received a left ventricular assist device (LVAD) (HeartWare International Inc., Framingham, MA, USA), a third-generation, continuous flow centrifugal pump, for destination therapy. AICD interrogation revealed development of atrial flutter coincident with worsening heart failure symptoms. Power consumption and pump diagnostics showed no LVAD malfunction. Cardioversion of atrial flutter followed transoesophageal echocardiography (TEE) showing no intracardiac thrombus. Real-time three-dimensional TEE ( Panel A ; Supplementary data online, …