Author + information
- Received November 23, 2012
- Accepted November 27, 2012
- Published online June 18, 2013.
A patient with a continuous-flow left ventricular assist device experienced debilitating lightheadedness after initiation of an oral vasodilator. On examination, a loud systolic crescendo-decrescendo murmur was heard over the right chest (A, black circle) near the outflow cannula (arrowheads). The clinical finding prompted further evaluation, and a transthoracic echocardiogram with color-flow Doppler imaging of the outflow cannula (O) suggested stenosis (S) near the aortic anastomosis (B and C, Online Video 1). Pulsed-wave Doppler imaging (D) through the narrowed portion of the cannula exhibited elevated blood-flow velocities during systole (S). In E, contrast-enhanced chest computed tomography showed impingement (asterisk) of the outflow conduit (O) proximal to the anastomosis to the aorta (A). A 3-dimensional volume-rendered computed tomography color reconstruction image clearly confirmed a kink (arrow) in the outflow cannula (F, Online Video 2). After withdrawal of the vasodilator, the patient’s symptoms improved, and the stenosis was managed conservatively.
Dr. Shah has received educational grants from Thoratec Corporation. Dr. Kasirajan has received research grants from Thoratec Corporation. Drs. Kontos and Parker have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 23, 2012.
- Accepted November 27, 2012.
- 2013 American College of Cardiology Foundation