title: The impact of prolonged rotary ventricular assist device support upon ventricular geometry and flow kinetics.
abstract: BACKGROUND
  The aim of this study was to determine the impact of prolonged left ventricular assist device (VAD) support on cardiac ventricular geometry and VAD flow kinetics.
  
  
  METHODS
  Nineteen patients with end-stage heart failure underwent the implantation of HeartMate II rotary flow VADs. Left and right ventricular geometry and VAD flow kinetics were assessed by transthoracic echocardiography early (7 ± 1 days) and late (113 ± 21 days) after VAD implantation.
  
  
  RESULTS
  Left ventricular end-diastolic internal dimension decreased by 21% and 35%, respectively, early and late after VAD implantation (n = 19; P < .001 vs before VAD implantation). Right ventricular end-diastolic internal dimension did not decrease at either time. Hemodynamic trends were similar. VAD inflow obstruction by myocardium was observed in eight patients, seven of whom demonstrated significantly increased variation of VAD inflow during the cardiac cycle ("pulsatility") detected by Doppler studies. Medical or surgical intervention returned VAD flow patterns toward baseline in seven of eight patients with VAD obstructions.
  
  
  CONCLUSIONS
  Prolonged rotary VAD support unloads the left ventricle, with modest effects on the right ventricle. These changes are often associated with alterations of VAD flow kinetics, requiring therapeutic intervention. These findings indicate the usefulness of echocardiographic surveillance in patients undergoing prolonged VAD support.
authors.affiliation: Carver College of Medicine, University of Iowa, Iowa City, IA, USA. robert-weiss@uiowa.edu
authors.forename: Robert M
authors.initials: RM
authors.lastname: Weiss
authors.forename: Richard E
authors.initials: RE
authors.lastname: Kerber
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Goerbig-Campbell
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Davis
authors.forename: Barry M
authors.initials: BM
authors.lastname: Cabuay
authors.forename: Guha
authors.initials: G
authors.lastname: Ashrith
authors.forename: Wassef
authors.initials: W
authors.lastname: Karrowni
authors.forename: James E
authors.initials: JE
authors.lastname: Davis
authors.forename: Frances L
authors.initials: FL
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D003326:Coronary Circulation; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011673:Pulsatile Flow; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery