Author + information
- Received June 22, 2013
- Accepted July 9, 2013
- Published online February 4, 2014.
- Nina Ghosh, MD∗,†,
- Alfonso H. Waller, MD∗,†,
- Elizabeth Rinehart, MD‡,
- Neal K. Lakdawala, MD∗,§,
- Yiannis S. Chatzizisis, MD, PhD∗,†,
- Robert Padera, MD, PhD‡,
- Gregory Couper, MD‖,
- Judy Mangion, MD∗ and
- Michael Steigner, MD†
- ∗Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
- †Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
- ‡Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
- §Brigham and Women's Hospital, VA Boston Health Care, Brigham and Women's Hospital, Boston, Massachusetts
- ‖Department of Cardiac Surgery, Harvard Medical School, Boston, Massachusetts
A 37-year-old man with a history of heart transplantation developed graft dysfunction and underwent total artificial heart (TAH) implantation. Post-implantation, the patient developed hypoxemia. Chest radiograph (A) showed normal positioning of the TAH inflow and outflow valves (yellow and white arrows, respectively) and drivelines (blue arrows). Three-dimensional, volume-rendered images with multiobject segmentation of the TAH and surrounding structures from a pulmonary embolism protocol computed tomography angiography negative for pulmonary embolism showed no evidence of pulmonary vein (red) compression by the anastomotic ring (yellow) as a cause of hypoxemia (B, Online Video 1). The patient subsequently developed tea-colored urine and low ventricular fill volumes, raising the suspicion for hemolysis through the inflow valves. Transesophageal echocardiography (TEE) (C, Online Video 2) showed normal motion of the single-leaflet tilting disc valve and stable transvalvular gradients compared with a previous TEE. En-face views of the inflow valves according to 3-dimensional TEE revealed no evidence of thrombus. Post-explant analysis confirmed the absence of thrombus on the inflow valves (D). This case demonstrates the complementary utility of 2- and 3-dimensional echocardiography and computed tomography in the assessment of TAH function.
Dr. Steigner has served as a speaker for Vital Signs. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 22, 2013.
- Accepted July 9, 2013.
- American College of Cardiology Foundation