Dynamic Left Ventricular Assist Device Inflow Obstruction
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A 72-year-old man with a history of rheumatic heart disease, prior bioprosthetic mitral and aortic valve replacement, severe nonischemic dilated cardiomyopathy (left ventricular [LV] ejection fraction 5%), and a history of ventricular tachycardia (VT) underwent implantation of a continuous flow LV assist device (LVAD; HeartMate II; Thoratec Corporation) as destination therapy for severe heart failure. The early postoperative period was unremarkable and he had substantial functional improvement with minimal cardiovascular limiting symptoms after postoperative recovery.
After ≈3 years on LVAD support, he experienced a series of appropriate implantable cardioverter-defibrillator shocks for sustained VT refractory to antiarrhythmic therapy. He underwent VT ablation targeting the basal LV inferoseptum, but he continued to have recurrent VT. Because VT seemed to originate from a deep septal substrate, he underwent an alcohol …