Pulsus Alternans as a Sign of Right Ventricular Failure After Left Ventricular Assist Device Implantation

J Card Fail. 2020 Dec;26(12):1093-1095. doi: 10.1016/j.cardfail.2020.09.010. Epub 2020 Sep 19.

Abstract

Temporary left ventricular assist devices such as the ImpellaTM are increasingly used in patients with cardiogenic shock. The right ventricle remains the Achilles heel of left ventricular assist device-supported circulation. However, right ventricular failure after implantation of a left ventricular assist device remains incompletely defined and understood. We describe the first case of pulsus paradoxus emerging after the initiation of circulatory support using a left ventricular ImpellaTM device, which is an early sign of right ventricular failure, that was completely abolished after the addition of a temporary right ventricular assist device.

Keywords: Heart failure; cardiopulmonary resuscitation and emergency critical care; mechanical circulatory support; right ventricular failure.

MeSH terms

  • Heart Failure* / diagnosis
  • Heart Ventricles / diagnostic imaging
  • Heart-Assist Devices* / adverse effects
  • Humans
  • Shock, Cardiogenic / diagnosis
  • Shock, Cardiogenic / etiology
  • Shock, Cardiogenic / therapy
  • Treatment Outcome
  • Ventricular Dysfunction, Right* / diagnostic imaging
  • Ventricular Dysfunction, Right* / etiology