Risk of left ventricular assist device as a bridge to heart transplant following postinfarction ventricular septal rupture.
Heart transplantation is an effective treatment for end-stage heart failure. However, due to the persistent shortage of donor hearts, many patients die awaiting a transplant. Implantable left ventricular assist devices are now available as a reliable bridge to cardiac transplantation. This report presents a patient with terminal heart failure as a result of a post-myocardial infarction ventricular septal rupture (VSR), who underwent a successful placement of the HeartMate left ventricular assist device (LVAD) and velour patch closure of an apical VSR. Despite this therapy, the patient expired after developing a second VSR, which created a high-flow right-to-left shunt and caused hypoxic irreversible brain injury. We suggest that use of a left ventricular assist device as a bridge to transplantation be approached with extreme caution in a patient with a postinfarction ventricular septal rupture.
Kshettry
V R
VR
Cardiac Surgical Associates, Minneapolis, MN 55407, USA.
Salerno
C T
CT
Bank
A J
AJ
D017548:Echocardiography, Transesophageal; D017809:Fatal Outcome; D006346:Heart Septum / Q000000981:diagnostic imaging; D016027:Heart Transplantation / Q000379:methods*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D012307:Risk Factors; D012422:Rupture, Spontaneous; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*