Management of three cardiogenic pulmonary edemas occurring in a patient scheduled for left ventricular assist device implantation: indicators for determining left ventricular assist device pump speed

Hiroaki Toyama, Yusuke Takei, Kazutomo Saito, Takahisa Ota, Kenji Kurotaki, Yutaka Ejima, Takeshi Matsuura, Masatoshi Akiyama, Yoshikatsu Saiki, Masanori Yamauchi

Research output: Contribution to journalArticlepeer-review

Abstract

A male patient with Marfan syndrome underwent aortic root replacement and developed left ventricular (LV) failure. Four years later, he underwent aortic arch and aortic valve replacement. Thereafter, his LV failure progressed, and cardiogenic pulmonary edema (CPE) appeared, which we treated with extracorporeal LV assist device (LVAD) placement. Three months later, the patient developed aspiration pneumonia, which caused hyperdynamic right ventricle (RV) and CPE. We treated by changing his pneumatic LVAD to a high-flow centrifugal pump. A month later, he underwent thoracoabdominal aortic replacement. After four weeks, he developed septic thrombosis and LVAD failure, which caused CPE. We treated with LVAD circuit replacement and an additional membrane oxygenator. Four months later, he underwent DuraHeart® implantation. During this course, pulmonary artery wedge pressure (PAWP) varied markedly. Additionally, systolic pulmonary artery pressure (sPAP), left atrial diameter (LAD), RV end-diastolic diameter (RVEDD) and estimated RV systolic pressure (esRVP) changed with PAWP changes. In this patient, LV failure and hyperdynamic RV caused the CPEs, which we treated by adjusting the LVAD output to the RV output. Determining LVAD output, RV function and LV end-diastolic diameter are typically referred, and PAWP, LAD, RVEDD, and sPAP could be also referred.

Original languageEnglish
Pages (from-to)711-715
Number of pages5
JournalJournal of Anesthesia
Volume30
Issue number4
DOIs
Publication statusPublished - 2016 Aug 1

Keywords

  • Cardiogenic pulmonary edema (CPE)
  • Left atrial diameter (LAD)
  • Left ventricular assist device (LVAD)
  • Left ventricular end-diastolic diameter (LVEDD)
  • Relative left ventricular failure

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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