Acquired Aortic Cusp Fusion After Chronic Left Ventricular Assist Device Support

Explanted hearts from patients with chronic left ventricular assist device (LVAD) support have shown the presence of aortic cusp fusion, which results in valvular stenosis and may complicate weaning of a LVAD. This is the first report of aortic cusp fusion diagnosed solely by transesophageal echocardiography (TEE) in vivo in a patient on chronic LVAD support. Under intraoperative TEE guidance, a 41-year-old woman underwent an attempted explantation of a LVAD, which had been implanted 8 months before for dilated cardiomyopathy. When LVAD support was discontinued, previously normal left ventricular function deteriorated, and aortic stenosis from aortic valve cusp fusion was documented by TEE. The explantation procedure was abandoned. This case demonstrates the utility of intraoperative TEE in the evaluation of aortic valvular anatomy and function in patients wtih chronic LVAD support.