Bidirectional Dynamic Change in Shunt Flow Across a Small Ventricular Septal Defect in a Patient With a Left Ventricular Assist Device

Abstract

A 50-year-old man implanted with a durable left ventricular assist device (LVAD; HeartMate 3, Abbott Laboratories, Chicago, IL) for idiopathic dilated cardiomyopathy was transferred to our hospital for further follow-up. He had not been diagnosed with any intracardiac shunts before LVAD implantation. On admission, echocardiography revealed a small left-to-right (L-R) shunt flow across the interventricular septum, indicating muscular ventricular septal defect (VSD). As the pump speed was raised during an echocardiographic ramp test for LVAD optimization, the L-R shunt flow at low pump speed (Fig.