Echocardiography for mechanical support

Abstract

In Chapter 20, TOE imaging relevant to the assessment of different forms of mechanical cardiorespiratory support is reviewed. Topics covered are intra-aortic balloon pumps, extracorporeal membrane oxygenation (ECMO), and ventricular assist devices (VADs); however, the focus of the chapter is on ECMO and VADs. For ECMO, both venovenous (VV) and venoarterial (VA) configurations are discussed. Issues such as cannula placement, assessment of complications (e.g. recirculation with VV ECMO, LV distension with VA ECMO), and weaning are dealt with. For left-sided VAD (LVAD) implantation, assessment during the pre- and post-implantation periods is outlined. Normal and abnormal flow patterns within the inflow and outflow cannulae are reviewed. Issues related to patent foramen ovale, RV dysfunction, AV dysfunction, and over-pumping and under-pumping are covered. Also, the indications for right-sided support in patients undergoing LVAD implantation are discussed.