title: Prolonged but successful weaning from left ventricular assist device after cardiac decompensation due to late-recognized coarctation of the aorta in a toddler.
abstract: A 2-year-old boy was presented with late-recognized coarctation of the aorta and pulmonary hypertension due to left ventricular failure. The coarctation was corrected at the day of admission with a good postoperative result. However, weaning from the respirator failed despite multiple drug support due to left ventricular failure. Consequently, a left ventricular assist device (LVAD) was implanted 22 days later. The further course was complicated by systemic hypertension and ongoing pulmonary hypertension requiring extensive antihypertensive therapy. The first attempt to wean from LVAD failed and the left ventricle was left completely unloaded for additional 4 weeks. The second weaning attempt, using a very smooth weaning protocol, led to a recovered left ventricle and facilitated the removal of the assist device after a total of 120 days. The patient was discharged with normal cardiac function, but he still requires antihypertensive therapy. We believe that the slow reduction of the LVAD support was the key measure that leads to the successful weaning of the patient, thereby avoiding heart transplantation.
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Pneumology, Allergology and Cystic Fibrosis, Medical University Innsbruck, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Meierhofer
authors.forename: Ludwig
authors.initials: L
authors.lastname: Mueller
authors.forename: Herwig
authors.initials: H
authors.lastname: Antretter
authors.forename: Juliane
authors.initials: J
authors.lastname: Kilo
authors.forename: Guenther
authors.initials: G
authors.lastname: Laufer
authors.forename: Peter
authors.initials: P
authors.lastname: Mair
authors.forename: Corinna
authors.initials: C
authors.lastname: Velik-Salchner
authors.forename: Martin
authors.initials: M
authors.lastname: Fruehwirth
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Neu
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Schermer
authors.forename: Jorrit
authors.initials: J
authors.lastname: Brunnemann
authors.forename: Ralf
authors.initials: R
authors.lastname: Geiger
authors.forename: Joerg-Ingolf
authors.initials: JI
authors.lastname: Stein
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schweigmann
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001011:Aorta / Q000503:physiopathology / Q000601:surgery; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000601:surgery*; D002227:Carbazoles / Q000627:therapeutic use; D000077261:Carvedilol; D002675:Child, Preschool; D020878:Device Removal; D006333:Heart Failure / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D007902:Length of Stay; D017706:Lisinopril / Q000627:therapeutic use; D008297:Male; D011412:Propanolamines / Q000627:therapeutic use; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000959:Antihypertensive Agents; D002227:Carbazoles; D011412:Propanolamines; D006852:Hydrochlorothiazide; D000077261:Carvedilol; D017706:Lisinopril