title: TandemHeart placement for cardiogenic shock in acute severe mitral regurgitation and right ventricular failure.
abstract: We report a case of a patient with severe mitral regurgitation (MR) due to infective endocarditis with preserved left ventricular systolic function complicated by severe pulmonary hypertension, right ventricular (RV) dysfunction, and cardiogenic shock. He was evaluated by cardiothoracic surgery for mitral valve replacement (MVR). It appeared that the high pulmonary artery pressure (PAP) had been chronic with acute worsening, thus raising concerns that it may not promptly reverse after MVR, putting him at high risk for postoperative RV failure and increasing the risk of mortality. A TandemHeart (TH) percutaneous ventricular assist device (pVAD) was placed with improvement in hemodynamics following which MVR was done. To our knowledge, this is the first report of the preoperative use of the TH pVAD in severe acute MR for hemodynamic stabilization in preparation for MVR.
authors.affiliation: Division of Cardiology, Baylor College of Medicine, Houston, Texas.
authors.forename: Ravi S
authors.initials: RS
authors.lastname: Hira
authors.forename: Alisa
authors.initials: A
authors.lastname: Thamwiwat
authors.forename: Biswajit
authors.initials: B
authors.lastname: Kar
mesh_terms: D004696:Endocarditis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D019918:Heart Valve Prosthesis Implantation; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D011300:Preoperative Care; D011474:Prosthesis Design; D020127:Recovery of Function; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
keywords: devices; hemodynamics; right ventricle; valvular heart disease; ventricular support