Images in Cardiovascular CT
Left ventricular assist device malposition interrogated by 4-D cine computed tomography

https://doi.org/10.1016/j.jcct.2011.01.009Get rights and content

Abstract

67-year-old female with left ventricular assist device (LVAD) presented with recurrent low-flow alarms. No clear etiology could be determined by history, or evaluation with radiograph and echocardiogram. Computed tomographic (CT) imaging with 3-D and 4-D assessment identified the abnormality as steep angulation of the inflow cannula and partial obstruction by the adjacent anterior wall, likely in part caused by recovered left ventricular function and reverse remodeling. Improved left ventricle size and function was correlated by semi-automated analysis of CT data, which also indicated mild right ventricle dilation and systolic dysfunction. LVAD explantation was performed, and has been well tolerated by the patient. Echocardiography remains the primary imaging modality to assess patients post LVAD placement, but in this instance CT provided valuable information to identify the abnormality and help direct patient management. CT assessment in patients with LVAD additionally provides valuable information prior to redo sternotomy for pump explantation, revision, or transplantation.

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    Citation Excerpt :

    To our knowledge, this is the largest cohort to incorporate CCT in the comprehensive assessment of cardiomechanical LVAD complications. Prior studies of CT imaging for LVAD complications have generally been case reports or small case series that evaluated only a single type of complication or highlighted the potential strengths of CT imaging for LVAD complications.5–11 These previous studies lacked quantitative data to support the additive diagnostic value of CCT in combination with TTE for the assessment of LVAD complications.

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Conflict of interest: The authors report no conflicts of interest.

Supplementary material for this article may be found at http://www.CardiacCTjournal.com.

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