3.18 Left Ventricular Assist Devices Part 2

In this episode, we review the use of imaging in assessing patients before and after LVAD implantation. What are concerning findings on pre-LVAD echocardiogram, other than an overly small left ventricular (LV) cavity? On post-LVAD echocardiogram, what emergency would be suggested by the combined findings of an increased left ventricular internal diameter at end diastole (LVIDd), worsened mitral regurgitation, septal shift toward the right ventricle, and increased aortic valve opening duration or frequency? What concerning development would be suggested by the combined findings of worsened tricuspid regurgitation, right ventricular enlargement, reduced right ventricular fractional area change, and septal shift toward the right ventricle? How does the PW Doppler tracing of LVAD inflow cannula interrogation differ from the PW Doppler tracing of LVAD outflow cannula interrogation? Does a higher S:D velocity ratio suggest better or worse LV function? Severe regurgitation of which valve produces a blind loop of flow? In assessing aortic regurgitation (AR) in a patient with an LVAD, why is not permissible to use AR pressure half time? The equation π×(RVOT radius)^2×RVOT VTI×HR is used to calculate what volume? What is a ramp study? When performing a ramp study, what maneuver results in a reduction in native mitral regurgitation volume, increase in the pulsatility of the LVAD outflow, and reduction in the frequency of native aortic valve opening and closing? What are reasons to terminate a ramp study? Tune in for answers to these questions.

Difficulty Level: Advanced

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