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Transient normalization of systolic and diastolic function after support with a left ventricular assist device in a
H R Levin1, M C Oz, K A Catanese
1Department of Medicine, Columbia Presbyterian Medical Center, New York, NY 10032, USA.
Insights
A young man with severe heart failure experienced temporary recovery with a left ventricular assist device (LVAD). However, his heart condition worsened, leading to death despite the device removal.
Area of Science:
- Cardiology
- Medical Devices
Background:
- Idiopathic dilated cardiomyopathy can cause fulminant heart failure.
- Left ventricular assist devices (LVADs) are used for heart failure management and as a bridge to transplantation.
Observation:
- A 19-year-old patient with dilated cardiomyopathy received an LVAD for 183 days.
- During LVAD support, the patient's cardiac function temporarily normalized.
Findings:
- The LVAD was explanted due to apparent cardiac recovery, and transplantation was averted.
- The patient later experienced cardiac dilation and worsening ejection fraction, succumbing to heart failure.
Implications:
- Temporary recovery of cardiac function during LVAD support, while uncommon, can occur.
- This case highlights the unpredictable nature of dilated cardiomyopathy and the importance of continued monitoring even after apparent recovery.
Abstract:
A 19-year-old man who had fulminant heart failure caused by an idiopathic dilated cardiomyopathy was supported with a left ventricular assist device for 183 days as a bridge to heart transplantation. At the time of intended transplantation it was noted that the patient's heart had returned to normal size, had a normal ejection fraction, and was able to maintain normal pressures and flows. In view of the apparent recovery of cardiac properties, the left ventricular assist device was explanted and the transplantation was not performed. However, the heart dilated, ejection fraction worsened, and the patient died of heart failure exacerbated acutely by a systemic viral illness. Although such recovery of systolic function is uncommon, as use of the left ventricular assist devices becomes more widespread other physicians might encounter similar findings and, in this regard, they might find our experience useful as they contemplate their treatment options.