title: Myocardial scarring caused by left ventricular assist device (LVAD) insertion demonstrated by cardiovascular magnetic resonance.
abstract: We report three cases of dilated cardiomyopathy treated with left ventricular assist devices (LVAD), subsequently explanted. These mechanical devices are being increasingly used to support left ventricular function in the short and long term. We used cine and gadolinium-enhanced cardiovascular magnetic resonance (CMR) to examine the consequences of previous LVAD implantation. In all cases, there was apical akinesis and tethering on cine imaging. Early (< 5 minutes) imaging after gadolinium demonstrated apical hypo-enhancement, an avascular area of scar or thrombus, while late (> 10 minutes) imaging demonstrated transmural apical infarction which in one case extended into the inferior wall. The findings suggest that LVAD insertion may cause permanent myocardial fibrosis at the site of ventricular insertion, and the cases demonstrate the use of contrast-enhanced CMR in this scenario of iatrogenic ventricular scarring.
authors.affiliation: Cardiovascular Magnetic Resonance Unit of the Royal Brompton Hospital, London, UK.
authors.forename: James C C
authors.initials: JC
authors.lastname: Moon
authors.forename: Burkhard
authors.initials: B
authors.lastname: Sievers
authors.forename: Dudley J
authors.initials: DJ
authors.lastname: Pennell
authors.forename: Magdi H
authors.initials: MH
authors.lastname: Yacoub
authors.forename: Raad H
authors.initials: RH
authors.lastname: Mohiaddin
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000601:surgery; D002921:Cicatrix / Q000175:diagnosis* / Q000209:etiology*; D003287:Contrast Media; D020878:Device Removal; D004868:Equipment Failure; D004869:Equipment Safety; D005260:Female; D019786:Gadolinium DTPA; D006352:Heart Ventricles / Q000601:surgery; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D009206:Myocardium / Q000473:pathology*; D018487:Ventricular Dysfunction, Left / Q000601:surgery
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA