title: Severe hypoxaemia with a left ventricular assist device in a minipig model with an undiagnosed congenital cardiac disease.
abstract: We describe the placement of a left ventricular assist device (LVAD) in a pig with spontaneously occurring atrial septal defect (ASD) (incidental finding) that created a right-left cardiac shunt, with subsequent severe hypoxaemia. Early diagnosis was critical in order to prevent end-organ damage due to hypoxaemia. Adequate monitoring alerted us to the deterioration in oxygenation, haemodynamics and cerebral oxygen metabolism. This forced us to change the level of assistance provided by the pump, and thus dramatically correct this impairment. Necropsy revealed an ostium secundum ASD. In conclusion, if hypoxaemia presents after implementation of an LVAD, the presence of a right-left shunt must be ruled out. The first step must be a judicious reduction in assist device flow to minimize intracardiac shunting. Subsequently, atrial septal closure of the defect should be considered. We report an experimental model of severe hypoxaemia after placement of an LVAD as part of a larger research project.
authors.affiliation: Department of Anaesthesiology, Reanimation and Intensive Care, Hospital General Universitario Gregorio Marañón, C/Doctor Esquerdo, 46, Madrid 28007, Spain. begoquinti@gmail.com
authors.forename: B
authors.initials: B
authors.lastname: Quintana-Villamandos
authors.forename: G J
authors.initials: GJ
authors.lastname: Rodríguez-Bernal
authors.forename: R
authors.initials: R
authors.lastname: Pérez-Caballero
authors.forename: J
authors.initials: J
authors.lastname: Otero
authors.forename: M
authors.initials: M
authors.lastname: Ruiz
authors.forename: M J
authors.initials: MJ
authors.lastname: Delgado-Martos
authors.forename: J J
authors.initials: JJ
authors.lastname: Sánchez-Hernández
authors.forename: E
authors.initials: E
authors.lastname: Delgado-Baeza
authors.forename: J F
authors.initials: JF
authors.lastname: Del Cañizo
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D006346:Heart Septum / Q000473:pathology; D006352:Heart Ventricles / Q000503:physiopathology; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006439:Hemodynamics; D000860:Hypoxia / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D013552:Swine / Q000601:surgery; D013556:Swine, Miniature / Q000601:surgery