Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 Jun;24(2):265-268.
doi: 10.1007/s10047-020-01210-y. Epub 2020 Sep 17.

Clinical potential of hemodynamic ramp test by simultaneous echocardiography and right heart catheterization for aortic insufficiency in a patient with continuous-flow left ventricular assist device

Yasumori Sujino  1 , Kensuke Kuroda  1 , Koichi Yoshitake  1 , Nobuichiro Yagi  1 , Eiji Anegawa  1 , Hiroki Mochizuki  1 , Keiichiro Iwasaki  1 , Seiko Nakajima  1 , Takuya Watanabe  1 , Masanobu Yanase  1 , Satsuki Fukushima  2 , Tomoyuki Fujita  2 , Junjiro Kobayashi  2 , Norihide Fukushima  3
Affiliations
Case Reports

Clinical potential of hemodynamic ramp test by simultaneous echocardiography and right heart catheterization for aortic insufficiency in a patient with continuous-flow left ventricular assist device

Yasumori Sujino et al. J Artif Organs. 2021 Jun.

Abstract

Aortic insufficiency (AI) is an important adverse event in patients with continuous-flow (CF) left ventricular assist device (LVAD) support. AI is often progressive, resulting in elevated 2-year morbidity and mortality. The effectiveness of echocardiographic ramp studies in patients with AI has been unclear. Here, we describe a patient with a CF-LVAD implant who underwent aortic valve replacement (AVR), following assessment of AI using a hemodynamic ramp test with simultaneous echocardiography and right heart catheterization (RHC). The patient was a 21-year-old man with cardiogenic shock due to acute myocarditis, who underwent HeartWare CF-LVAD (HVAD) implantation. Heart failure persisted despite increased doses of diuretics and inotrope, as well as an increased HVAD pump rate. HVAD monitoring revealed a correlation between increased HVAD pump rate and flow at each speed step. A hemodynamic ramp test with simultaneous transthoracic echocardiography and RHC revealed a significant discrepancy between HVAD pump flow and cardiac output (CO) at each speed step; moreover, pulmonary capillary wedge pressure remained high. Therefore, the patient underwent AVR. Subsequently, his low CO symptoms disappeared and inotropes were successfully discontinued. A postoperative hemodynamic ramp test revealed that AVR had successfully closed the loop of blood flow and reduced the discrepancy between HVAD pump flow and CO, thereby increasing CO. The patient was then discharged uneventfully. In conclusion, a hemodynamic ramp test with simultaneous echocardiography and RHC was useful for the evaluation of the causal relationship between AI and low CO, and for selection of surgical treatment for AI in a patient with CF-LVAD.

Keywords: Aortic valve insufficiency; Aortic valve replacement; Cardiac output; Heart-assist devices; Pulmonary wedge pressure.

PubMed Disclaimer

Conflict of interest statement

There is no conflict of interests related to this manuscript.

Figures

Fig. 1
Fig. 1
Results of hemodynamic ramp test before and after aortic valve replacement (AVR) (a and b). LVEDD left ventricular end-diastolic diameter, HVAD flow HeartWare continuous-flow left ventricular assist device pump flow calculated by ventricular assist device monitoring, CO cardiac output calculated by right heart catheterization, PCWP pulmonary capillary wedge pressure, rpm rotations per minute
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Cowger J, Rao V, Massey T, Sun B, May-Newman K, Jorde U, Estep JD. Comprehensive review and suggested strategies for the detection and management of aortic insufficiency in patients with a continuous-flow left ventricular assist device. J Heart Lung Transplant. 2015;34:149–157. doi: 10.1016/j.healun.2014.09.045. - DOI - PubMed
    1. Toda K, Fujita T, Domae K, Shimahara Y, Kobayashi J, Nakatani T. Late aortic insufficiency related to poor prognosis during left ventricular assist device support. Ann Thorac Surg. 2011;92:929–934. doi: 10.1016/j.athoracsur.2011.04.115. - DOI - PubMed
    1. John R, Mantz K, Eckman P, Rose A, May-Newman K. Aortic valve pathophysiology during left ventricular assist device support. J Heart Lung Transplant. 2010;29:1321–1329. doi: 10.1016/j.healun.2010.06.006. - DOI - PubMed
    1. Holley CT, Fitzpatrick M, Roy SS, Alraies MC, Cogswell R, Souslian L, Eckman P, John R. Aortic insufficiency in continuous-flow left ventricular assist device support patients is common but does not impact long-term mortality. J Heart Lung Transplant. 2017;36:91–96. doi: 10.1016/j.healun.2016.07.018. - DOI - PubMed
    1. Sayer G, Sarswat N, Kim GH, Adatya S, Medvedofsky D, Rodgers D, Kruse E, Ota T, Jeevanandam V, Lang R, Uriel N. The hemodynamic effects of aortic insufficiency in patients supported with continuous-flow left ventricular assist devices. J Card Fail. 2017;23:545–551. doi: 10.1016/j.cardfail.2017.04.012. - DOI - PubMed

Publication types

MeSH terms