Left Ventricular Assist Device Implantation Induced Tricuspid Valve Prolapse

Abstract

A 46-year-old nonsmoking male patient without significant medical history was referred to our intensive care unit for cardiogenic shock. Progressive dyspnea developed during the past 2 weeks. Heart rate was at 120 beats per minute and blood pressure at 80/60 mm Hg at admission. Physical examination revealed cool extremities with bilateral leg edema, jugular venous distension, systolic murmur, and S3 gallop. ECG showed sinus tachycardia without ST segment abnormality. Chest radiograph showed cardiomegaly and bilateral alveolar infiltrates. Bedside echocardiography revealed a dilated left ventricle (LV) at 80 mm and a poor LV function (LV ejection fraction measured at 10% and forward stroke volume at 27 mL) without valvular disease. Right ventricular (RV) function was normal (tricuspid annular plane systolic excursion at 22 mm and peak tricuspid tissue Doppler S wave at 12 mm/s). Renal and liver dysfunctions were found on laboratory data. Coronary angiography was normal. Cardiac MRI showed a dilated cardiomyopathy without perfusion abnormality or late gadolinium enhancement and a normal RV. The use of loop diuretic and inotropic support produced significant improvement in symptoms, hemodynamic status, and end-organ function. Because …