Abstract
Objectives:
Cerebral vascular events can be encountered in patients supported by left ventricular assist devices (LVADs). Power motion-mode transcranial Doppler (TCD) is a new technique that we use in our LVAD patients to detect real time perioperative cerebral blood flow and embolus monitoring.
Methods:
We studied 11 patients with LVADs using a series of TCD examinations. TCD results were correlated with clinical and imaging findings.
Results:
Eleven patients (4M, 7 F; average age: 49yrs) underwent LVAD placement because of ischemic (5) and non-ischemic (6) cardiomyopathies. A total of 15 TCD studies were performed on this population which included 3 Micromed DeBakey LVADs and 8 HeartMate I devices for an average of 1 to 42 days after implantation. Three additional TCDs were also performed at 12, 24, and 36 month intervals. Four neurological events were recorded in 3 patients which included 3 TIAs and one CVA during the study period. An average of 33.2 microembolic signals per minute (range 0.2 to 40) were recorded in these patients immediately following the neurologic event. „Ghost“ artifacts were detected in three of the patients who did not have neurologic events.
Conclusions:
Power motion-mode can be used as a guide for TCD examination to improve accuracy in intracranial disease diagnosis and in the detection of embolization in multiple cerebral arteries at the same time. TCD examination can help determine the etiology of the LVAD patient's neurological deficit and can help guide anticoagulation by measuring the cerebral microemboli particle count.