TandemHeart placement for cardiogenic shock in acute severe mitral regurgitation and right ventricular failure

Authors

  • Ravi S. Hira MD,

    Corresponding author
    1. Division of Cardiology, Baylor College of Medicine, Houston, Texas
    • Correspondence to: Ravi S. Hira, M.D., Baylor College of Medicine, 1709 Dryden Rd, Suite 5.82a, Houston, TX 77030. E-mail: hira@bcm.edu

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  • Alisa Thamwiwat MD,

    1. Division of Cardiology, Baylor College of Medicine, Houston, Texas
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  • Biswajit Kar MD

    1. Division of Cardiology, Baylor College of Medicine, Houston, Texas
    2. Center for Advanced Heart Failure at Memorial Hermann Heart & Vascular Institute, Texas Medical Center and University of Texas Medical School at Houston, Houston, Texas
    3. Division of Cardiology, Michael E. DeBakey VA Medical Center, Division of Cardiology, Houston, Texas
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  • Conflict of interest: Nothing to report.

Abstract

We report a case of a patient with severe mitral regurgitation (MR) due to infective endocarditis with preserved left ventricular systolic function complicated by severe pulmonary hypertension, right ventricular (RV) dysfunction, and cardiogenic shock. He was evaluated by cardiothoracic surgery for mitral valve replacement (MVR). It appeared that the high pulmonary artery pressure (PAP) had been chronic with acute worsening, thus raising concerns that it may not promptly reverse after MVR, putting him at high risk for postoperative RV failure and increasing the risk of mortality. A TandemHeart (TH) percutaneous ventricular assist device (pVAD) was placed with improvement in hemodynamics following which MVR was done. To our knowledge, this is the first report of the preoperative use of the TH pVAD in severe acute MR for hemodynamic stabilization in preparation for MVR. © 2013 Wiley Periodicals, Inc.

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