Echocardiography in mechanical circulatory support

Abstract

Echocardiography is the front line modality in the evaluation of advanced heart failure patients requiring mechanical circulatory support. The use of continuous-flow left ventricular assist devices (LVADs) continues to expand across numerous centers in the country, as both a bridge to transplantation and as destination therapy. Patients being evaluated for LVAD therapy require thorough pre-operative cardiac evaluation by echocardiography of biventricular function, the aortic, tricuspid and mitral valves, the ascending aorta, the atria and atrial septum. After LVAD implantation, echocardiography can effectively evaluate flow velocities into the apical inflow cannula and from the ascending aorta outflow cannula, left ventricular decompression, frequency of aortic valve opening, right ventricular function and degree of aortic, mitral and tricuspid regurgitation. Patients with suspected LVAD malfunction should undergo urgent echocardiography to help identify possible causes, including hypovolemia, valvular dysfunction, tamponade, thrombosis and cannula malposition. Echocardiography also plays a key role in the evaluation and management of patients with percutaneous catheter devices that provide temporary mechanical support in cardiogenic shock and during high risk cardiovascular procedures. It is important to become competent in the echocardiographic assessment of patients who are being evaluated for and receiving mechanical circulatory support, as they can develop critical complications that can be managed successfully if promptly diagnosed.