The use of a durable right ventricular assist device for isolated right ventricular failure due to combined pre- and postcapillary pulmonary hypertension

Abstract

Patients with isolated right ventricular (RV) failure have poor outcomes and minimal treatment options. We report a case where a durable RV assist device (RVAD) was implanted for end-stage RV failure from combined pre- and postcapillary pulmonary hypertension (PH) due in part to chronic thromboembolic PH using a temporary percutaneous RVAD as a bridging strategy. While the patient ultimately died from non-cardiovascular causes, there was significant improvement in markers of cardiogenic shock and hemodynamic RV function parameters without adverse effects from increased pulmonary artery pressures. More research is needed to identify an appropriate long-term mechanical support strategy for this patient population.

Keywords: CTEPH; PH; Protek Duo; RV failure; RVAD; mechanical circulatory support.

Fig. 1.

Transthoracic echocardiogram images obtained in the parasternal short-axis view in diastole from the patient. (a) Before any right ventricular mechanical support and demonstrates marked RV dilation and interventricular septal flattening. (b) After placement of the Protek Duo device showing partial improvement in septal shift and (c) After placement of durable RVAD and highlights significant improvement in RV dimensions and septal position.