Clinical Evaluation of Spontaneous Echo Contrast and Thrombus in the Left Ventricle by Transesophageal Echocardiography during Cardiac Assist

Abstract

This study examined the relation between the grade of spontaneous echo contrast (SEC) and ventricular blood flow velocity, and examined the usefulness of transesophageal echocardiography (TEE) in managing the patient with a left ventricular assist device (LVAD) in regard to left ventricular thrombus formation. We performed TEE in a patient who received an LVAD because of severe left heart failure. The grade of SEC decreased gradually as decreased the blood flow volume of the centrifugal pump in LVAD. Oppositely, the grade of SEC increased as increased the blood flow volume of the pump. The change was completed in about 10 s. There was no difference between the data for coagulation at 1 liter/min of the pump and that at 4 liters/min. A thrombus in the left venticle was found by TEE on the 2nd day after LVAD, and the size of the thrombus increased gradually. The patient died on the 7th postoperative day. Autopsy revealed that the size and location of the thrombus detected by TEE was accurate. We conclude that (1) it is proved clinically that the grade of SEC is related to blood flow velocity in the ventricle and SEC is completed in only about 10 s; (2) in patients with LVAD, TEE can provide accurate information on left ventricular thrombus formation.