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BMJ Case Reports 2018; doi:10.1136/bcr-2017-223893
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Echocardiographic evaluation of ‘sandwich plug’ closure of mechanical aortic valve at left ventricular assist device implantation

  1. John S McNeil1
  1. 1Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, USA
  2. 2Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
  1. Correspondence to Dr Amanda Kleiman, ak8zg{at}hscmail.mcc.virginia.edu
  • Accepted 17 January 2018
  • Published 8 February 2018

Description

A 67-year-old man with a history of non-ischaemic cardiomyopathy (ejection fraction 15%–20%) and previous mechanical aortic valve replacement presented for HeartMate II left ventricular assist device (LVAD) implantation due to worsening heart failure symptoms (New York Heart Association III–IV). After redo sternotomy, the aortic valve was closed with a prefashioned occluder device (figure 1). After occluder placement, the aortic cross-clamp was removed and the valve assessed with transoesophageal echocardiography (TOE) to ensure proper closure (figures 2–4, videos 1–3). Once satisfactory closure was confirmed, a HeartMate II LVAD was inserted.

Figure 1

Mechanical aortic valve prosthesis occluder constructed of felt, braided polyester sutures, and vascular clips prior to implantation.

Figure 2

The mid-oesophageal aortic valve long-axis view confirming complete occlusion/closure of the aortic valve without leaflet motion. Ao, aorta; AV, aortic valve; LA, left atrium; LV, left ventricle.

Figure 3

Colour flow Doppler across the left ventricular outflow tract (LVOT) in the mid-oesophageal aortic valve long-axis view confirmed a lack of flow across the LVOT and complete closure of the mechanical valve. Ao, aorta; AV, aortic valve; LA, left atrium; LV, left ventricle. …

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