A common complication following implantation of a ventricular assist device (VAD) is acute right heart failure. To manage this complication effectively, left ventricular preload and contractility must be estimated reliably.

A 66-year-old female with end-stage heart failure was implanted with a HeartAssist 5 (from Micromed Cardiovascular Inc. of Houston) with a custom Transonic® Flowprobe on the VAD’s outflow graft to continuously measure real-time pump blood flow. On days one and two post-op, mean flow through the graft was 4.8 L/min. On day three post-op, real-time flow began a progressive decline that was accompanied by an increase in central venous pressure and progressive renal failure.

By day 10 post-op, the patient had to be placed on VA extracorporeal membrane oxygenation (ECMO). The ECMO circuit included a CentriMag pump with a “Transonic Inside” flow board and a H9XLA Flowsensor. Real-time flow and pulsatility recovered immediately and the ECMO circuit was disconnected on day 14 post-op. The patient’s further recovery was uneventful.

Monitoring of the left ventricular preload and contractility throughout the post-operative period with Transonic® real-time flow measurement helped both in the diagnosis and the management of right heart failure, including the weaning from ECMO.