Loss of Left Ventricular Vortex Ring in Left Ventricular Assist Device-Induced Right Ventricular Failure : Annals of Cardiac Anaesthesia

Secondary Logo

Journal Logo

Advanced Search
Letters to Editor

Loss of Left Ventricular Vortex Ring in Left Ventricular Assist Device-Induced Right Ventricular Failure

Akiyama, Koichi1,2,3,; Wu, Isaac2; Itatani, Keiichi4; Tachibana, Yosuke3; Obata, Yurie3; Takayama, Hiroo2

Author Information

1Department of Surgery, Division of Cardiothoracic Surgery, New York, USA

2Department of Anesthesiology, Columbia University Medical Center, New York, USA

3Department of Anesthesiology, Yodogawa Christian Hospital, NY, USA

4Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan

Address for correspondence: Dr. Koichi Akiyama, Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, 177 Fort Washington Avenue, New York - 10032, NY, USA. E-mail: [email protected]

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 4.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Annals of Cardiac Anaesthesia 26(2):p 235, Apr–Jun 2023. | DOI: 10.4103/aca.aca_288_20
  • Open

Normal blood flow in the left ventricle, which demonstrates vortex ring formation during diastole, plays a very important role. The vortex ring facilitates inflow into the left ventricle, minimizes the dissipation of energy, preserves momentum, and redirects flow towards the left ventricular outflow tract in an energy-efficient manner.[1] Right ventricular (RV) failure after left ventricular assist device (LVAD) implantation is a major cause of morbidity and mortality. LVAD flow can induce interventricular septal (IVS) flattening which in turn can cause RV failure, due to ventricular interdependence.[2] Figure 1 shows two intraoperative transesophageal echocardiographic images of the midesophageal long axis view following LVAD (HeartMate3, St Jude Medical) implantation. The image was analyzed using newly developed vector flow mapping software (Cardio Flow Design, Tokyo),[3] which determines blood flow patterns from both color Doppler and wall tracking data. At an optimal pump speed of 5000 RPM (left panel) the left heart appears appropriately filled with a normal vortex blood flow pattern (yellow arrows) during diastole.

F1
Figure 1:
Vector flow mapping images of left ventricle with LVAD

Concurrent pulmonary artery and central venous pressure (PAP, CVP) waveforms reflect preserved RV function. However, at an elevated pump speed of 6500 RPM (right panel), the left heart appears underfilled with IVS flattening, and vortex ring formation is lost [Figure 1]. This resulted in a flat PAP waveform and increased CVP, consistent with RV dysfunction [Figure 1]. This suggests that the loss of left ventricular vortex ring formation may identify RV failure due to IVS flattening in patients with an LVAD.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

REFERENCES

1. Akiyama K, Maeda S, Matsuyama T, Kainuma A, Ishii M, Naito Y, et al. Vector flow mapping analysis of left ventricular energetic performance in healthy adult volunteers. BMC Cardiovasc Disord 2017;17:21.
2. Moon MR, Castro LJ, DeAnda A, Tomizawa Y, Daughters GT 2nd, Ingels NB Jr, et al. Right ventricular dynamics during left ventricular assistance in closed-chest dogs. Ann Thorac Surg 1993;56:54–66;discussion 66-7.
3. Itatani K, Okada T, Uejima T, Tanaka T, Ono M, Miyaji K, et al. Intraventricular flow velocity vector visualization based on the continuity equation and measurements of vorticity and wall shear stress. Jpn J Appl Phys 2013;52:07HF16.
Copyright: © 2023 Annals of Cardiac Anaesthesia