Heartmate II implantation with right coronary bypass grafting in ischemic cardiomyopathy with "fixed" pulmonary hypertension: treatment strategy to protect right ventricular function.
A 49-year-old male patient suffering from end-stage ischemic cardiomyopathy with a left ventricular ejection fraction below 15% was presented to redo coronary artery bypass grafting (CABG). Coronary angiogram demonstrated an occluded left anterior descending artery and occluded right coronary artery, perfused retrogradely from the circumflex artery. Since positron emission tomography did not demonstrate viable left ventricular myocardium except for the basis of the left ventricle, CABG was considered futile. Cardiac transplantation was contra-indicated due to pharmacologically unresponsive pulmonary artery hypertension. The patient successfully underwent left ventricular assist device implantation in combination with right coronary artery revascularization. The article reflects the regimen of right ventricular preservation in this patient.
Sommer
Sebastian-Patrick
SP
Departments of Cardiac-, Thoracic-, and Thoracic Vascular Surgery, University Hospital of Würzburg, Würzburg, Germany. Sommer_S1.htc@klinik.uni-wuerzburg.de
Gorski
Armin
A
Aleksic
Ivan
I
Yildirim
Cagatay
C
Schimmer
Christoph
C
Beissert
Matthias
M
Weininger
Markus
M
Leyh
Rainer G
RG
D002311:Cardiomyopathy, Dilated / Q000628:therapy*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery / Q000628:therapy; D006353:Heart-Assist Devices; D006801:Humans; D006976:Hypertension, Pulmonary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D013318:Stroke Volume; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right