title: Management of three cardiogenic pulmonary edemas occurring in a patient scheduled for left ventricular assist device implantation: indicators for determining left ventricular assist device pump speed.
abstract: A male patient with Marfan syndrome underwent aortic root replacement and developed left ventricular (LV) failure. Four years later, he underwent aortic arch and aortic valve replacement. Thereafter, his LV failure progressed, and cardiogenic pulmonary edema (CPE) appeared, which we treated with extracorporeal LV assist device (LVAD) placement. Three months later, the patient developed aspiration pneumonia, which caused hyperdynamic right ventricle (RV) and CPE. We treated by changing his pneumatic LVAD to a high-flow centrifugal pump. A month later, he underwent thoracoabdominal aortic replacement. After four weeks, he developed septic thrombosis and LVAD failure, which caused CPE. We treated with LVAD circuit replacement and an additional membrane oxygenator. Four months later, he underwent DuraHeart(®) implantation. During this course, pulmonary artery wedge pressure (PAWP) varied markedly. Additionally, systolic pulmonary artery pressure (sPAP), left atrial diameter (LAD), RV end-diastolic diameter (RVEDD) and estimated RV systolic pressure (esRVP) changed with PAWP changes. In this patient, LV failure and hyperdynamic RV caused the CPEs, which we treated by adjusting the LVAD output to the RV output. Determining LVAD output, RV function and LV end-diastolic diameter are typically referred, and PAWP, LAD, RVEDD, and sPAP could be also referred.
authors.affiliation: Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan. h-toyama@umin.ac.jp.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Toyama
authors.affiliation: Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Takei
authors.affiliation: Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan.
authors.forename: Kazutomo
authors.initials: K
authors.lastname: Saito
authors.affiliation: Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Ota
authors.affiliation: Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kurotaki
authors.affiliation: Division of Surgical Center and Supply, Sterilization, Tohoku University Hospital, Sendai, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ejima
authors.affiliation: Division of Clinical Engineering, Tohoku University Hospital, Sendai, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsuura
authors.affiliation: Department of Cardiovascular Surgery, Tohoku University School of Medicine, Sendai, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Akiyama
authors.affiliation: Department of Cardiovascular Surgery, Tohoku University School of Medicine, Sendai, Japan.
authors.forename: Yoshikatsu
authors.initials: Y
authors.lastname: Saiki
authors.affiliation: Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, Sendai, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Yamauchi
mesh_terms: D000328:Adult; D001011:Aorta / Q000503:physiopathology; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000503:physiopathology; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D011654:Pulmonary Edema / Q000601:surgery*; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D018497:Ventricular Dysfunction, Right / Q000209:etiology; D016278:Ventricular Function, Right
keywords: Cardiogenic pulmonary edema (CPE); Left atrial diameter (LAD); Left ventricular assist device (LVAD); Left ventricular end-diastolic diameter (LVEDD); Relative left ventricular failure