Novel Application of a Percutaneous Left Ventricular Assist Device as a Bridge to Transplant in a Pediatric Patient with Severe Heart Failure Due to Viral Myocarditis

2015 Resident Video Competition Award Winner

Objectives

The authors describe their experience using a percutaneous left ventricular assist device (LVAD) as a bridge to transplant in a morbidly obese pediatric patient with severe heart failure due to viral myocarditis. Prior similar reports are extremely limited. This video demonstrates a minimally invasive, effective, and well-tolerated treatment option for select patients with reversible severe heart failure.

Methods

This video case report explains the indications for the procedure, interventional decision-making, implantation technique, and clinical outcome. Associated discussion includes advantages and disadvantages of the device in this setting, as well as the institutional (University of California Davis) algorithm for management of viral myocarditis-associated severe heart failure.

Results

Following device insertion, the patient experienced rapid improvement in symptoms. The LVAD provided effective left ventricular unloading for 50 days, promoting myocardial recovery and maintaining excellent patient performance status. The device placement strategy allowed for a high level of activity, including completion of school-work and participation in a weight loss program. The patient achieved a 28-pound weight loss, thus improving candidacy for transplantation. Removal of the device was well tolerated and post-removal cardiac function was satisfactory. Echocardiography revealed an improvement in the left ventricular ejection fraction from 22% at baseline to 38% after device removal.

Conclusions

This case represents a successful application of a percutaneous LVAD as a bridge to transplant in a pediatric patient with severe heart failure due to viral myocarditis. For select patients with this condition, a trans-axillary LVAD should be considered as a therapeutic option, as it is well tolerated and provides effective left ventricle unloading to promote myocardial recovery and maintain performance status.

All images shown are used with permission of the patient and her mother.