Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jan 26, 2017; 9(1): 55-59
Published online Jan 26, 2017. doi: 10.4330/wjc.v9.i1.55
Simultaneous ramp right heart catheterization and echocardiography in a ReliantHeart left ventricular assist device
Dipanjan Banerjee, Debleena Dutt, Sebastien Duclos, Karim Sallam, Matthew Wheeler, Richard Ha
Dipanjan Banerjee, Debleena Dutt, Sebastien Duclos, Karim Sallam, Matthew Wheeler, Richard Ha, Divisions of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
Author contributions: All authors contributed to the acquisition of data, writing, and revision of this manuscript.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at University of Alabama in Birmingham.
Informed consent statement: No protected health information was utilized in the generation of this case report, thus no patient consent was required.
Conflict-of-interest statement: Dr. Banerjee D and Ha R receive research support and speaker honoraria from Medtronic and St. Jude; all other authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dipanjan Banerjee, MD, MS, Divisions of Cardiovascular Medicine, Stanford University School of Medicine, Falk CVRB 275, 870 Quarry Rd, Stanford, CA 94305, United States. dipanjan@stanford.edu
Telephone: +1-650-7244942 Fax: +1-650-4987452
Received: July 7, 2016
Peer-review started: July 14, 2016
First decision: September 12, 2016
Revised: September 17, 2016
Accepted: November 16, 2016
Article in press: November 17, 2016
Published online: January 26, 2017
Processing time: 195 Days and 6.4 Hours
Abstract

Many clinicians caring for patients with continuous flow left ventricular assist devices (CF-LVAD) use ramp right heart catheterization (RHC) studies to optimize pump speed and also to troubleshoot CF-LVAD malfunction. An investigational device, the ReliantHeart Heart Assist 5 (Houston, TX), provides the added benefit of an ultrasonic flow probe on the outflow graft that directly measures flow through the CF-LVAD. We performed a simultaneous ramp RHC and echocardiogram on a patient who received the above CF-LVAD to optimize pump parameters and investigate elevated flow through the CF-LVAD as measured by the flow probe. We found that the patient’s hemodynamics were optimized at their baseline pump speed, and that the measured cardiac output via the Fick principle was lower than that measured by the flow probe. Right heart catheterization may be useful to investigate discrepancies between flow measured by a CF-LVAD and a patient’s clinical presentation, particularly in investigational devices where little clinical experience exists. More data is needed to elucidate the correlation between the flow measured by an ultrasonic probe and cardiac output as measured by RHC.

Keywords: Left ventricular assist devices, Right heart catheterization, Ramp study, Flow estimation

Core tip: Commercially available left ventricular assist devices estimate flow through the device, but a new investigational device with an ultrasonic flow probe directly measures flow. Despite a reported accuracy in the flow probe’s measurement of flow, we found that this value was inaccurate in a patient whose flows were discrepant to the patient’s clinical status by performing echocardiography and right heart catheterization. Care should be taken to verify technical advances in mechanical circulatory support, and both imaging and hemodynamic evaluations can help clinicians make more informed decisions.