Cardiac muscle training
- Patients with refractory heart failure due to chronic progressive cardiac myopathy (CM) may require mechanical circulatory support as a bridge to transplantation. A few patients can be weaned from support devices if recovery can be achieved. The identification of these patients is of great importance as recovery may be missed if the heart is unloaded by the ventricular assist device (VAD). Testing the load-bearing capacity of the supported left ventricle (LV) by temporarily and gradually reducing mechanical support during cardiac exercise can help identify responders and potentially aid the recovery process. An exercise training protocol was used in 3 patients (8 months, 18 months and 8 years old) with histological CM findings and myocarditis. They were monitored regularly using clinical information and functional imaging with VAD support. Echocardiographic examination included both conventional real-time 3D echocardiography (RT3DE) and speckle tracking (ST). A daily temporary reduction in pump rate (phase A) was followed by a permanent reduction in rate (phase B). Finally, pump stops of up to 30 min were performed once a week (phase C). The final decision on explantation was based on at least three pump stops. Two patients were weaned and successfully removed from the VAD. One of them was diagnosed with acute viral myocarditis. The other had chronic myocarditis with dilated myopathy and mild interstitial fibrosis. The noninvasive assessment of cardiac output and strain under different loading conditions during VAD therapy is feasible and helps identify candidates for weaning despite severe histological findings. The presented protocol, which incorporates new echocardiographic techniques for determining volume and deformation, can be of great help in positively guiding the process of individual recovery, which may be essential for selecting and increasing the number of patients to be weaned from VAD.
Author: | Anca RacoltaGND, Jae-Hyun Johannes AhnGND, Marinos KantzisORCiDGND, Hendrik MiltingORCiDGND, Volker LauenrothGND, Hermann KörperichORCiDGND, Eugen SandicaGND, Stephan SchubertORCiDGND, Kai Thorsten LaserORCiDGND |
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URN: | urn:nbn:de:hbz:294-103404 |
DOI: | https://doi.org/10.3390/life12111681 |
Parent Title (English): | Life |
Subtitle (English): | a new way of recognizing and supporting recovery for LVAD patients in the pediatric population |
Publisher: | MDPI |
Place of publication: | Basel, Schweiz |
Document Type: | Article |
Language: | English |
Date of Publication (online): | 2023/11/07 |
Date of first Publication: | 2022/10/22 |
Publishing Institution: | Ruhr-Universität Bochum, Universitätsbibliothek |
Tag: | Open Access Fonds Berlin Heart; assist device; congestive heart failure; dilatative cardiomyopathy; myocarditis; weaning |
Volume: | 12 |
Issue: | 11, Article 1681 |
First Page: | 1681-1 |
Last Page: | 1681-13 |
Note: | Article Processing Charge funded by the Deutsche Forschungsgemeinschaft (DFG) and the Open Access Publication Fund of Ruhr-Universität Bochum. |
Institutes/Facilities: | Herz- und Diabeteszentrum NRW |
Herz- und Diabeteszentrum NRW, Kinderherzzentrum / Zentrum für angeborene Herzfehler | |
Dewey Decimal Classification: | Technik, Medizin, angewandte Wissenschaften / Medizin, Gesundheit |
open_access (DINI-Set): | open_access |
Licence (English): | Creative Commons - CC BY 4.0 - Attribution 4.0 International |