title: Left ventricular support by axial flow pump: the echocardiographic approach to device malfunction.
abstract: Axial flow pumps have gained increased acceptance in recent years as a bridge to heart transplantation and, more recently, as destination therapy. As left ventricular (LV) assist device dysfunction will be increasingly prevalent, the aim of our work was to introduce an echocardiographic management protocol as a guide to recognize the causes of pump failure. In this article we describe the echocardiographic approach to 5 episodes of malfunction of an axial flow pump (DeBakey, MicroMed Technology Inc, Houston, Tex) in 4 patients: 4 episodes caused by thrombosis of LV assist device and one caused by abnormal increase of systemic vascular resistance. In our experience, echocardiography played a pivotal role in clinical management of LV assist device failure. It allowed us to: assess patency and position of inflow and outflow cannulae; research the source of thromboembolic material; assess adequate LV filling and unloading; and optimize right ventricular function, volume replacement therapy, and pharmacologic support.
authors.affiliation: Division of Cardiothoracic Anesthesia and Intensive Care, Department of Cardio-Thoracic Surgery A. De Gasperis, Niguarda Cà Granda Hospital, Milan, Italy. emanuele.catena@tin.it
authors.forename: Emanuele
authors.initials: E
authors.lastname: Catena
authors.forename: Filippo
authors.initials: F
authors.lastname: Milazzo
authors.forename: Emanuela
authors.initials: E
authors.lastname: Montorsi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bruschi
authors.forename: Aldo
authors.initials: A
authors.lastname: Cannata
authors.forename: Claudio
authors.initials: C
authors.lastname: Russo
authors.forename: Alberto
authors.initials: A
authors.lastname: Barosi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Tartara
authors.forename: Roberto
authors.initials: R
authors.lastname: Paino
authors.forename: Ettore
authors.initials: E
authors.lastname: Vitali
mesh_terms: D004452:Echocardiography / Q000379:methods*; D004868:Equipment Failure; D019544:Equipment Failure Analysis / Q000379:methods*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology*