Ann Thorac Surg 2002;74:586-588
© 2002 The Society of Thoracic Surgeons
Case report
Implantation of a left ventricular assist device in situs inversus
Michele Musci, MD*a,c,
Michael J. Jurmann, MDa,c,
Thorsten Drews, MDa,c,
Charles Yankah, MD, PhDa,c,
Hermann Kuppe, MD, PhDb,c,
Yuguo Weng, MD, PhDa,c,
Roland Hetzer, MD, PhDa,c
a Department of Cardiothoracic, Deutsches Herzzentrum Berlin, Berlin, Germany
b Department of Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
c Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
Accepted for publication December 5, 2001.
* Address reprint requests to Dr Musci, Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
e-mail: musci{at}dhzb.de
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Abstract
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A 42-year-old man with situs inversus was referred to our institution because of end-stage ischemic cardiomyopathy. Cardiac arrest occurred after admission, and the patient underwent cardiopulmonary resuscitation. An extracorporeal left ventricular assist device (Berlin Heart) was implanted as a bridge to transplantation. This is one of the first reports of left ventricular assist device implantation in a patient with situs inversus and ischemic cardiomyopathy.
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Introduction
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The use of mechanical circulatory support devices in the treatment of advanced heart failure has steadily increased as waiting times for heart transplant recipients have lengthened. First developed to permanently replace the failing heart, these devices are now used mainly as a mechanical bridge to heart transplantation. Here we present the case of a patient with situs inversus and ischemic cardiomyopathy who had development of severe heart failure and required a left ventricular assist device.
A 42-year-old man with situs inversus, end-stage ischemic cardiomyopathy (Fig 1),
and a high-dose regime of positive inotropic medication was referred to our institution to be evaluated for heart transplantation. Shortly after admission, cardiac arrest occurred, and the patient underwent cardiopulmonary resuscitation. Echocardiographic examination showed a large, globally hypokinetic left ventricle (left ventricular ejection fraction, 0.15; left ventricular end-diastolic diameter, 70 mm) and moderate right ventricular function (right ventricular ejection fraction, 0.30). A left ventricular assist device was necessary as a bridge to transplantation. After median sternotomy and initiation of cardiopulmonary bypass, an extracorporeal left ventricular assist device (Berlin Heart) was implanted with a left ventricular apical cannula on the right side and an outflow graft implanted into the ascending aorta (Fig 2).
The early postoperative course was uneventful, and the patient was discharged home with a wearable driving unit (Excor; Mediport, Berlin, Germany).
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Fig 1. (A) Anteroposterior and (B) lateral chest roentgenograms showing dilated heart in situs inversus.
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Fig 2. Extracorporeal left ventricular assist device for patient with situs inversus. Blood is drained from the left apex on the right side and pumped into the ascending aorta.
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Comment
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This is one of the first reports in the literature of left ventricular assist device implantation in a patient with situs inversus and ischemic cardiomyopathy. When considering which device to choose for mechanical circulatory support, both the expected length of support and the underlying disease have to be considered [1]. Patients who are bridged to heart transplantation will be on the waiting list for a substantial period, and therefore degree of mobility becomes an important issue. For this patient, we chose the Berlin Heart device, which consists of a polyurethane translucent pumping chamber with two mechanical heart valves and silicone cannulas that connect the device transcutaneously with the patient’s heart. Although there are several paracorporeal pneumatically driven systems available, the advantage of this system is the great variety of cannulas and ventricles, thus allowing a broad application. It can be used in newborns and children as well as in adults in a univentricular or biventricular fashion [2]. Because of the wearable driving unit, patients can be discharged home to await orthotopic heart transplantation.
Several reports have documented successful heart transplantation in patients with situs inversus. They all have in common redirection of the systemic venous return from the left side to the right side using various types of intracardiac baffles. A newer technique involves a composite conduit made of the recipient right atrium and pericardium that can be used to connect the left superior vena cava and the hepatic veins to the right-sided atrium of the donor heart [3–5].
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Acknowledgments
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We are grateful for the editorial assistance of Ms A. Gale and the bibliographic work of Ms A. Benhennour.
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References
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- Loebe M., Mueller J., Hetzer R. Ventricular assistance for recovery of cardiac failure. Curr Opin Cardiol 1999;14:234-238.[Medline]
- Hetzer R., Loebe M., Potapov E.V., et al. Circulatory support with pneumatic paracorporeal ventricular assist device in infants and children. Ann Thorac Surg 1998;66:1498-1506.[Abstract/Free Full Text]
- Bailey L. Heart transplantation techniques in complex congenital heart disease. J Heart Lung Transplant 1993;12:S168-S175.[Medline]
- Doty D.B., Renlund D.G., Caputo G.R., et al. Cardiac transplantation in situs inversus. J Thorac Cardiovasc Surg 1990;99:493-499.[Abstract]
- Rubay J.E., d’Udekem Y., Sluysmans T., Ponlot R., Jacquot L., de Leval M.R. Orthotopic heart transplantation in situs inversus. Ann Thorac Surg 1995;60:460-462.[Abstract/Free Full Text]
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Abstract
Introduction
