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Iacobelli R, Di Molfetta A, Amodeo A. Echocardiographic imaging and ventricular mechanics in pulsatile-flow LVAD pediatric patients: a systematic approach. Front Pediatr 2024; 12:1345891. [PMID: 38348212 PMCID: PMC10860755 DOI: 10.3389/fped.2024.1345891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/10/2024] [Indexed: 02/15/2024] Open
Abstract
Echocardiography plays a crucial role in determining the eligibility for left ventricular assist device (LVAD) placement in patients experiencing advanced heart failure (HF) and in monitoring patient care after the implantation procedure. Because of its unique nature, pediatric population and pulsatile-flow LVADs used in pediatrics require specific skills so that pediatric echocardiographers must develop a systematic approach in order to image the patients pre and post LVAD implantation. Therefore, the purpose of this narrative review is to delineate a systematic echocardiographic approach for pediatric patients supported by pulsatile-flow LVADs.
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Affiliation(s)
- R. Iacobelli
- Pediatric Cardiology Unit, Clinical Area of Fetal and Cardiovascular Science, Bambino Gesù Children’s Hospital, Rome, Italy
| | - A. Di Molfetta
- Cathetherization Laboratory, Fabrizio Spaziani Hospital, Frosinone, Italy
| | - A. Amodeo
- Heart Failure Unit, Cardiac Transplantation and MCS, Clinical Area of Fetal and Cardiovascular Science, Bambino Gesù Children’s Hospital, Rome, Italy
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Burkule N, Bansal M, Govind S, Alagesan R, Ponde C, Parashar S. Corrected and Republished: Indian Academy of Echocardiography Guidelines for Performance of Transesophageal Echocardiography in Adults. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2022. [DOI: 10.4103/jiae.jiae_54_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Echocardiography for left ventricular assist device implantation and evaluation: an indispensable tool. Heart Fail Rev 2021; 27:891-902. [PMID: 33428013 DOI: 10.1007/s10741-021-10073-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
Echocardiography is an indispensable tool in the evaluation, placement, management and follow-up of patients with left ventricular assist devices (LVAD). While transoesophageal echocardiography is the ideal tool in guiding the implantation procedure, transthoracic echocardiography is essential during the initial evaluation, patient selection and in the post-operative follow-up. This review attempts to summarize which parameters the echocardiographic assessment should focused on during each step. In particular, during the pre-operative assessment, it is of paramount importance to assess the presence of aortic regurgitation and most importantly to evaluate right ventricular function, since it is one of the strongest predictor of post-implant right ventricular failure. During the procedure, through transoesophageal echocardiography, it is possible to confirm the correct placement of the inflow cannula, to assess right ventricular function and to guide the choice of the right pump speed. Transthoracic echocardiographic is an essential part in the patient's follow-up once the LVAD has been implanted, in order to attest the onset of possible complications.
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Burkule N, Bansal M, Govind S, Alagesan R, Ponde C, Parashar S. Indian Academy of Echocardiography Guidelines for Performance of Transesophageal Echocardiography in Adults. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2021. [DOI: 10.4103/jiae.jiae_39_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Dandel M, Javier MFDM, Javier Delmo EMD, Hetzer R. Accurate assessment of right heart function before and after long-term left ventricular assist device implantation. Expert Rev Cardiovasc Ther 2020; 18:289-308. [DOI: 10.1080/14779072.2020.1761790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Michael Dandel
- Department of Cardiology, Cardio Centrum Berlin, Berlin, Germany
| | | | | | - Roland Hetzer
- Department of Cardiothoracic and Vascular Surgery, Cardio Centrum Berlin, Berlin, Germany
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Di Molfetta A, Iacobelli R, Ferrari G, Filippelli S, Perri G, Toscano A, Adorisio R, Guccione P, Amodeo A. A New 2D Echocardiographic Approach to Evaluate the Membrane and Valve Movement of the Berlin Heart EXCOR VAD Chamber in Pediatric VAD Patients. Artif Organs 2018; 42:451-456. [PMID: 29667250 DOI: 10.1111/aor.13122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/30/2017] [Accepted: 01/04/2018] [Indexed: 11/26/2022]
Abstract
The use of Berlin Heart EXCOR VAD (BH) is a validated therapy to bridge pediatric patients to heart transplant. Serial echocardiographic (ECHO) assessment of VAD patients is necessary to support patients' management. This work aims at developing an innovative strategy to evaluate the BH device functioning by ECHO and its interaction with the native heart in a pediatric population. ECHO evaluation of BH membrane movement, and inflow and outflow valves was performed in 2D, 2D-color Doppler, M-mode, and M-mode color Doppler to assess the functioning of the device by direct positioning of the ECHO probe on the BH cannulas and membranes. Forty Berlin Heart EXCOR VAD were analyzed in 18 patients. Seven BH were placed as RVAD and 33 as LVAD. Results evidenced that 14 (21) inflow (outflow) valves presented a mild regurgitation, while 5 inflow (3 outflow) valves presented a moderate regurgitation. In three cases, we observed severe valve regurgitation with back flow in the left ventricle/right atrium. In both cases, the BH chambers were substituted, but we observed that in one case the regurgitation was due to cannulas compression, while in the other case it was due to valve malfunctioning. The M-mode and the ECHO of the membranes and valves permitted to appreciate the beat phenomenon to assess if the native heart and the BH are working in opposite or in the same phase. The membrane ECHO permits evaluation of minimal changes in membrane movement to assure the completely empty-completely fully work modality. Systematic ECHO assessment of BH chamber might support the BH programming and the detection of anomalous VAD-heart interaction.
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Affiliation(s)
- Arianna Di Molfetta
- Department of Pediatric Cardiology and Cardiac Surgery, -Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Roberta Iacobelli
- Department of Pediatric Cardiology and Cardiac Surgery, -Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Gianfranco Ferrari
- Nalecz Institute of Technology- Department of Biocybernetics and Biomedical Engineer-Warsaw, Poland
| | - Sergio Filippelli
- Department of Pediatric Cardiology and Cardiac Surgery, -Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Gianluigi Perri
- Department of Pediatric Cardiology and Cardiac Surgery, -Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Alessandra Toscano
- Department of Pediatric Cardiology and Cardiac Surgery, -Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Rachele Adorisio
- Department of Pediatric Cardiology and Cardiac Surgery, -Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Paolo Guccione
- Department of Pediatric Cardiology and Cardiac Surgery, -Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Antonio Amodeo
- Department of Pediatric Cardiology and Cardiac Surgery, -Ospedale Pediatrico Bambino Gesù, Rome, Italy
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Willemsen D, Cordes C, Bjarnason-Wehrens B, Knoglinger E, Langheim E, Marx R, Reiss N, Schmidt T, Workowski A, Bartsch P, Baumbach C, Bongarth C, Phillips H, Radke R, Riedel M, Schmidt S, Skobel E, Toussaint C, Glatz J. [Rehabilitation standards for follow-up treatment and rehabilitation of patients with ventricular assist device (VAD)]. Clin Res Cardiol Suppl 2016; 11 Suppl 1:2-49. [PMID: 26882905 DOI: 10.1007/s11789-015-0077-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The increasing use of ventricular assist devices (VADs) in terminal heart failure patients provides new challenges to cardiac rehabilitation physicians. Structured cardiac rehabilitation strategies are still poorly implemented for this special patient group. Clear guidance and more evidence for optimal modalities are needed. Thereby, attention has to be paid to specific aspects, such as psychological and social support and education (e.g., device management, INR self-management, drive-line care, and medication).In Germany, the post-implant treatment and rehabilitation of VAD Patients working group was founded in 2012. This working group has developed clear recommendations for the rehabilitation of VAD patients according to the available literature. All facets of VAD patients' rehabilitation are covered. The present paper is unique in Europe and represents a milestone to overcome the heterogeneity of VAD patient rehabilitation.
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Affiliation(s)
- Detlev Willemsen
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland.
| | - C Cordes
- Gollwitzer-Meier-Klinik, Bad Oeynhausen, Deutschland
| | - B Bjarnason-Wehrens
- Institut für Kreislaufforschung und Sportmedizin, Deutsche Sporthochschule Köln, Köln, Deutschland
| | | | - E Langheim
- Reha-Zentrum Seehof der DRV-Bund, Teltow, Deutschland
| | - R Marx
- MediClin Fachklinik Rhein/Ruhr, Essen, Deutschland
- Universität Witten/Herdecke, Witten, Deutschland
| | - N Reiss
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - T Schmidt
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - A Workowski
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - P Bartsch
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - C Baumbach
- Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Deutschland
| | - C Bongarth
- Klinik Höhenried, Bernried am Starnberger See, Deutschland
| | - H Phillips
- Reha Parcs Steinhof, Erkrath, Deutschland
| | - R Radke
- Christiaan-Barnard-Klinik, Dahlen-Schmannewitz, Dahlen, Deutschland
| | - M Riedel
- Klinik Fallingbostel, Bad Fallingbostel, Deutschland
| | - S Schmidt
- Gollwitzer-Meier-Klinik, Bad Oeynhausen, Deutschland
| | - E Skobel
- Rehaklinik "An der Rosenquelle", Aachen, Deutschland
| | - C Toussaint
- m&i Fachklinik Herzogenaurach, Herzogenaurach, Deutschland
| | - J Glatz
- Reha-Zentrum Seehof der DRV-Bund, Teltow, Deutschland
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Mehta N, Chokshi NP, Kirkpatrick JN. Cardiac imaging in the geriatric population: what do we think we know, and what do we need to learn? Prog Cardiovasc Dis 2014; 57:204-14. [PMID: 25216620 DOI: 10.1016/j.pcad.2014.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cardiac imaging plays an important role in coronary artery disease (CAD), congestive heart failure (HF) and valvular heart disease (VHD) in the elderly. Imaging defines the structure and function of the cardiac system, refining the understanding of patients' anatomy and physiology and informing a host of clinical care decisions, including prognosis. Yet there is a paucity of evidence to guide the rational use of many imaging modalities in patients of advanced age, a population with considerable clinical heterogeneity, high prevalence and burden of cardiovascular disease (CVD) and atypical presentations of CVD. This paper discusses important considerations for cardiac imaging for older adults, particularly in regard to CAD, VHD and HF, and then presents domains for future research to produce data that would inform clinical care guidelines, appropriate use criteria and imaging lab protocols to address the unique needs of the fast-growing elderly population.
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Affiliation(s)
- Nidhi Mehta
- Echocardiography Laboratory, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Neel P Chokshi
- Echocardiography Laboratory, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - James N Kirkpatrick
- Echocardiography Laboratory, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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Firstenberg MS, Sai-Sudhakar CB, Anyanwu A. Valvular disease in patients requiring long-term left ventricular assist devices: pathophysiology and therapeutic options. Expert Rev Cardiovasc Ther 2014; 10:205-13. [DOI: 10.1586/erc.11.189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Feldman D, Pamboukian SV, Teuteberg JJ, Birks E, Lietz K, Moore SA, Morgan JA, Arabia F, Bauman ME, Buchholz HW, Deng M, Dickstein ML, El-Banayosy A, Elliot T, Goldstein DJ, Grady KL, Jones K, Hryniewicz K, John R, Kaan A, Kusne S, Loebe M, Massicotte MP, Moazami N, Mohacsi P, Mooney M, Nelson T, Pagani F, Perry W, Potapov EV, Eduardo Rame J, Russell SD, Sorensen EN, Sun B, Strueber M, Mangi AA, Petty MG, Rogers J. The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: Executive summary. J Heart Lung Transplant 2013; 32:157-87. [DOI: 10.1016/j.healun.2012.09.013] [Citation(s) in RCA: 850] [Impact Index Per Article: 77.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 09/14/2012] [Indexed: 02/08/2023] Open
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11
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Echocardiographic Evaluation of Ventricular Assist Devices in Pediatric Patients. J Am Soc Echocardiogr 2013; 26:41-9. [DOI: 10.1016/j.echo.2012.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Indexed: 11/23/2022]
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Nunes SS, Song H, Chiang CK, Radisic M. Stem cell-based cardiac tissue engineering. J Cardiovasc Transl Res 2011; 4:592-602. [PMID: 21748529 DOI: 10.1007/s12265-011-9307-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 06/26/2011] [Indexed: 10/18/2022]
Abstract
Cardiovascular diseases are the leading cause of death worldwide, and cell-based therapies represent a potential cure for patients with cardiac diseases such as myocardial infarction, heart failure, and congenital heart diseases. Towards this goal, cardiac tissue engineering is now being investigated as an approach to support cell-based therapies and enhance their efficacy. This review focuses on the latest research in cardiac tissue engineering based on the use of embryonic, induced pluripotent, or adult stem cells. We describe different strategies such as direct injection of cells and/or biomaterials as well as direct replacement therapies with tissue mimics. In this regard, the latest research has shown promising results demonstrating the improvement of cardiac function with different strategies. It is clear from recent studies that the most important consideration to be addressed by new therapeutic strategies is long-term functional improvement. For this goal to be realized, novel and efficient methods of cell delivery are required that enable high cell retention, followed by electrical integration and mechanical coupling of the injected cells or the engineered tissue to the host myocardium.
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Affiliation(s)
- Sara S Nunes
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College St. Rosebrugh Building, Toronto, ON, Canada, M5S 3G9.
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