What is this device?

October 26, 2013

Cardiac, Chest XR, Non-Trauma, XR

What is this device?


This patient has two devices on Chest Xray and KUB:

1.  The large, radiodense structure just below the cardiac silhouette is a Left Ventricular Assist Device (LVAD).  Specifically it is a Heartmate II®.  LVADs are implanted in patients with severe cardiac depression for augmented left ventricular output.  Often these are implanted in patients awaiting cardiac transplant, however we are seeing more patients with implanted LVADs for “Destination Therapy.”  This is a long-term treatment for severe CHF with no intention of eventual cardiac transplantation.   The goal of these devices is to improve quality-of-life in severe CHF.  Complications most-often include thrombotic (ischemic stroke) or hemorrhagic (patients require anticoagulation with these devices which predisposes them to GI, CNS, other hemorrhagic events). 

2.  He has an Automatic Implantable Cardiverter Defibrillator (AICD) in the left upper chest.  It also functions as a pacemaker. 

A word of warning:  some of these patients will not have pulses because these devices provide a continuous left ventricular output.  A good way to obtain a blood pressure is to manually inflate the blood pressure cuff with a doppler transducer on the radial artery, as you release the blood pressure cuff you will obtain a doppler signal at some point.  This is your blood pressure (a single number).  Often they will have pulsatile flow if the intrinsic function of the heart provides enough stroke volume on top of the LVAD. 

Author:  Russell Jones, MD


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