Monitoring of Aortic Valve Opening and Systolic Aortic Insufficiency in Optimization of Continuous-Flow Left Ventricular Assist Device Settings

Abstract

AORTIC INSUFFICIENCY (AI) in patients after left ventricular assist device (LVAD) implantation is one of the unintended and potentially harmful consequences. 1 Frazier O.H. Unforeseen consequences of therapy with continuous-flow pumps. Circ Heart Fail. 2010; 3: 647-649 Crossref PubMed Scopus (31) Google Scholar , 2 Cowger J. Pagani F.D. Haft J.W. et al. The development of aortic insufficiency in LVAD supported patients. Circ Heart Fail. 2010; 3: 668-674 Crossref PubMed Scopus (273) Google Scholar Excessive LVAD flows, resulting in diminished and infrequent aortic valve (AV) opening, may facilitate AI progression and extend its duration to the systolic phase of the cardiac cycle. 2 Cowger J. Pagani F.D. Haft J.W. et al. The development of aortic insufficiency in LVAD supported patients. Circ Heart Fail. 2010; 3: 668-674 Crossref PubMed Scopus (273) Google Scholar , 3 Hatano M. Kinugawa K. Shiga T. et al. Less frequent opening of the aortic valve and a continuous flow pump are risk factors for postoperative onset of aortic insufficiency in patients with a left ventricular assist device. Circ J. 2011; 75: 1147-1155 Crossref PubMed Scopus (89) Google Scholar The high temporal resolution of the echocardiographic M mode makes it very effective in monitoring the effects of LVAD speeds on AV function in real time. This case report describes the pathophysiology of AV leaflets akinesis and systolic aortic insufficiency in patients supported with continuous-flow LVAD and shows the grayscale and color M-mode AV surveillance in the perioperative optimization of the LVAD setting.