Case Report:
A 59-year-old male patient with stage D congestive heart failure, NYHA
class IV and severe right ventricular dysfunction with severe tricuspid
regurgitation underwent Heartware ventricular assist device (HVAD)
implantation and tricuspid valve annuloplasty. Due to the inability to
maintain adequate Oxygenation, a right-sided ECMO was implanted allowing
successful weaning from cardiopulmonary bypass. The immediate
postoperative course was remarkable for the implantation of a temporary
RVAD due to the inability to wean the patient from the right-sided ECMO.
With gradual improvement of the right ventricular function, the RVAD
could be removed approximately 1 month after its implantation. With
further improvement of the patient´s condition in general and the right
ventricular function in particular, the patient could be discharged home
after 6 months postoperatively with a total hospital stay of
approximately 9 months. 1 year later, the patient was readmitted with
new-onset acute heart failure. Transthoracic echocardiography (TTE)
revealed severe aortic regurgitation in both systolic and diastolic
phases with substance defect in the non-coronary leaflet with volume
overload of the left ventricle, VC 2 mm, and regurgitant jet width in
LVOT of 6mm (> 25% of LVOT -diameter, 23mm), and severe
right ventricular systolic dysfunction. In the LVAD-outflow graft from
the right parasternal view a systolic velocity of 207 cm/s and a
diastolic one of 129 cm/s with S/D-Ratio 1.6 (suggesting a
hemodynamically relevant AI with a ratio < 5). Due to the
patient’s high operative risk and the unfavorable anatomy a trial of
medical treatment along with optimization of LVAD flow was attempted,
but was unfortunately unsuccessful in improving the patient’s symptoms.
Accordingly, the patient was listed as a candidate for urgent heart
transplantation, and the operation was done successfully 7 months later.
The patient was weaned from the ventilator on the 6thpostoperative day and was discharged home after approximately 3 months
with post-operative transthoracic echocardiography revealing the normal
systolic function of both ventricles.