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A heartless patient
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  1. M F L Meijs,
  2. M J M Cramer,
  3. M Prokop
  1. m.prokop{at}umcutrecht.nl

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A 43-year-old male patient who suffered from ventricular tachycardia was diagnosed with arrhythmogenic right ventricular cardiomyopathy. He was treated with antiarrhythmic drugs and an implantable cardiac defibrillator. More than a year later he was admitted with signs of right and left-sided heart failure. The echocardiogram showed a dilated cardiomyopathy in which both ventricles were involved. A few months later he developed progressive end stage heart failure with cardiogenic shock, despite intensive medical treatment, due to recurrent (non-)sustained ventricular tachycardia.

A Thoratec biventricular assist device was implanted as a bridge to transplantation. During the procedure a cardiectomy was performed as the very thin wall of both ventricles prevented insertion of inlet cannulas. Both partially remaining atria were enlarged by a vascular graft allowing access of the inlet cannulas of the device. The outlet grafts were end-to-end connected with the great arteries. A tissue-expander was left behind in the pericardial cavity to preserve space for a future donor heart.

After surgery, 64-slice computed tomography (Philips Brilliance 64) was used to obtain a three-dimensional overview demonstrating successful implantation of the mechanical biventricular assist device (Panel A and online supplementary figs 13) and the tissue expander (Panel B and online supplementary fig 4).

Panel A. (See also supplementary figures 13). The biventricular assist device connects the right atrium (RA) to the pulmonary artery (PA), and the left atrium (LA) to the aorta (Ao).
Panel B. (See also supplementary figure 4). Note the tube and the valve of the tissue expander.

Acknowledgments

This article has been adapted from Meijs M F L, Cramer M J M, Prokop M. A heartless patient Heart 2008;94:560

Footnotes