title: Left ventricular assist device malfunction: an approach to diagnosis by echocardiography.
abstract: OBJECTIVE
  A protocol using transthoracic echocardiography was designed to diagnose the common malfunctions of patients on chronic support with a left ventricular assist device (LVAD).
  
  
  BACKGROUND
  Mechanical circulatory support, primarily with a LVAD, is increasingly used for treatment of advanced heart failure as a bridge to transplant and for long-term treatment of heart failure. The LVAD dysfunction is a recognized complication. To date, no studies have defined the role of transthoracic echocardiography in evaluating long-term mechanical complications of chronic LVAD support.
  
  
  METHODS
  Transthoracic echocardiography was used in a protocol designed to detect the common types of mechanical malfunction. Patients were followed up with serial echocardiograms, and clinical validations were made with findings from a catheter-based protocol and inspection at the time of cardiac transplant or corrective surgery.
  
  
  RESULTS
  Thirty-two patients with 44 LVADs were followed up during a four-year period using this protocol that correctly identified 11 patients with inflow valve regurgitation, 2 with intermittent inflow conduit obstruction, 1 with severe kinking of the outflow graft, and 9 with new insufficiency of the native aortic valve.
  
  
  CONCLUSIONS
  As LVAD use for end-stage heart failure becomes widespread, and durations of support are extended, dysfunction will be increasingly prevalent. Transthoracic echocardiography provides a practical method to accurately identify the causes of mechanical dysfunction with patients on chronic LVAD support.
authors.affiliation: Department of Cardiology, LDS Hospital, Salt Lake City, Utah, USA. schorton@msn.com
authors.forename: Steven C
authors.initials: SC
authors.lastname: Horton
authors.forename: Reza
authors.initials: R
authors.lastname: Khodaverdian
authors.forename: Peter
authors.initials: P
authors.lastname: Chatelain
authors.forename: Marsha L
authors.initials: ML
authors.lastname: McIntosh
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Horne
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Muhlestein
authors.forename: James W
authors.initials: JW
authors.lastname: Long
mesh_terms: D000328:Adult; D000368:Aged; D017548:Echocardiography, Transesophageal; D004868:Equipment Failure; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity