Clinical use of percutaneous mechanical circulatory assistance in a patient with end-stage right-sided heart failure and massive tricuspid insufficiency due to congenital heart disease: first-in-the-world case report.
Case report
Congenital heart disease
Ebstein's anomaly
Impella RP
Percutaneous mechanical circulatory support
Percutaneous right ventricular assist device
Right ventricular failure
Journal
European heart journal. Case reports
ISSN: 2514-2119
Titre abrégé: Eur Heart J Case Rep
Pays: England
ID NLM: 101730741
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
received:
13
01
2021
revised:
12
02
2021
accepted:
22
06
2021
entrez:
19
8
2021
pubmed:
20
8
2021
medline:
20
8
2021
Statut:
epublish
Résumé
Due to improvement in the management of patients with congenital heart disease (CHD), the likelihood of their survival to adulthood is increasing. A relevant population suffers end-stage right ventricular failure (RVF) in their 3rd-4th decade of life. Hence, heart transplantation is still gold standard of treatment of end-stage heart failure, mechanical circulatory assistance has become a valuable tool in the bridging to heart transplant or definitive therapy. Use of implantable short-term or long-term devices is reported by others. However, within this clinical context, presence of significant tricuspid regurgitation (TR) or CHD is used as exclusion criteria for insertion of a percutaneous right ventricular circulatory support. We described a 36-year-old patient diagnosed with Ebstein's anomaly and severe TR who is admitted to hospital due to RVF refractory to standard medical treatment. After case presentation to the heart team, an Impella RP device insertion was scheduled, in spite of the presence of TR or CHD after evaluation of pulmonary valve competency and 3D reconstruction with virtual device implantation. During support, the patient improved clinically and haemodynamically. Due to device displacement to the right ventricle, it was bedside explanted after 30 days of support. After mechanical unloading during 30 days patients' right ventricle recovered partially, permitting patient to improve his functional class. Although TR and CHD are exclusion criteria for the implantation of the Impella RP device, we report clinical experience in patient with Ebstein's anomaly and severe TR supported with percutaneous device as bridge to heart transplantation during 30 days.
Sections du résumé
BACKGROUND
BACKGROUND
Due to improvement in the management of patients with congenital heart disease (CHD), the likelihood of their survival to adulthood is increasing. A relevant population suffers end-stage right ventricular failure (RVF) in their 3rd-4th decade of life. Hence, heart transplantation is still gold standard of treatment of end-stage heart failure, mechanical circulatory assistance has become a valuable tool in the bridging to heart transplant or definitive therapy. Use of implantable short-term or long-term devices is reported by others. However, within this clinical context, presence of significant tricuspid regurgitation (TR) or CHD is used as exclusion criteria for insertion of a percutaneous right ventricular circulatory support.
CASE SUMMARY
METHODS
We described a 36-year-old patient diagnosed with Ebstein's anomaly and severe TR who is admitted to hospital due to RVF refractory to standard medical treatment. After case presentation to the heart team, an Impella RP device insertion was scheduled, in spite of the presence of TR or CHD after evaluation of pulmonary valve competency and 3D reconstruction with virtual device implantation. During support, the patient improved clinically and haemodynamically. Due to device displacement to the right ventricle, it was bedside explanted after 30 days of support. After mechanical unloading during 30 days patients' right ventricle recovered partially, permitting patient to improve his functional class.
DISCUSSION
CONCLUSIONS
Although TR and CHD are exclusion criteria for the implantation of the Impella RP device, we report clinical experience in patient with Ebstein's anomaly and severe TR supported with percutaneous device as bridge to heart transplantation during 30 days.
Identifiants
pubmed: 34409247
doi: 10.1093/ehjcr/ytab269
pii: ytab269
pmc: PMC8364766
doi:
Types de publication
Case Reports
Langues
eng
Pagination
ytab269Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
Références
J Heart Lung Transplant. 2015 Dec;34(12):1549-60
pubmed: 26681124
J Cardiothorac Vasc Anesth. 2018 Oct;32(5):2339-2343
pubmed: 30093192
J Heart Lung Transplant. 2014 Aug;33(8):794-9
pubmed: 24726682
Cardiol Clin. 2015 Nov;33(4):503-12, vii
pubmed: 26471815
J Heart Lung Transplant. 2018 Dec;37(12):1448-1458
pubmed: 30241890
Cardiol Clin. 2012 May;30(2):303-10
pubmed: 22548820
Eur J Heart Fail. 2016 Mar;18(3):226-41
pubmed: 26995592
Circulation. 2018 May 15;137(20):e578-e622
pubmed: 29650544