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Background Ventricular assist device (VAD) recipients are at high risk of depression and anxiety, and poor psychosocial functioning is associated with worse medical outcomes. Purpose We present a case of a 31-year-old depressed patient who demonstrated passive suicidal behavior through multiple episodes of noncompliance, including temporarily discontinuing warfarin (Coumadin) several months after VAD implantation. The patient's psychosocial and medical histories and outcomes are presented. Conclusions This case underscores the importance of pre-VAD as well and ongoing psychosocial evaluation and management for this unique patient population. Clinical implications Medical teams who are treating patients with cardiovascular disease who are under consideration for VAD or heart transplantation need to be aware of the multitude of ways in which patients can express depressed and suicidal mood and work with a multidisciplinary team to treat such symptoms to optimize patients' success with VAD/heart transplantation.

Twelve heart transplant recipients selected for conversion from cyclosporine to tacrolimus because of adverse effects of cyclosporine therapy underwent echocardiography at baseline and 6 months after conversion. Left ventricular mass decreased by 24% and left ventricular geometry returned toward normal at 6 months after conversion, without significant changes in blood pressure.

The era of mechanical circulatory support (MCS) began in 1953 with the development of cardiopulmonary bypass to facilitate open heart surgery.1 In 1964, the National Heart Institute (now the National Heart, Lung, and Blood Institute) funded the Artificial Heart Program and became actively involved in MCS development. This led to requests for Proposals issued in 1977 and 1980, which laid the foundation for the development of implantable MCS for long-term use, including devices capable of hospital discharge, in the 1990s. Although heart transplantation is now commonplace at many hospitals, the inadequate supply of donor hearts and patient contraindications to transplantation continue to severely restrict its application. As the demand for long-term replacement of diseased hearts increases, there is a clear need for innovative, safe, and durable MCS to treat the growing population of patients with advanced heart failure (HF). Many exciting changes in the field of MCS have occurred in the past few years, including the development of smaller portable pumps and the concept of destination therapy (DT), or permanent pump placement as an alternative to heart transplantation. Currently, there are no published guidelines for the use of MCS. Thus, it is our intent that this statement will provide the contemporary cardiologist and other HF providers with an understanding of general considerations when determining the appropriateness of MCS. There is little hope that complete consensus will ever be reached on the definition of advanced HF, but most physicians caring for such patients on a regular basis readily identify the characteristics of these patients. Advanced HF patients are those with clinically significant circulatory compromise who require special care, including consideration for heart transplantation, continuous intravenous inotropic therapy, MCS, or hospice.2,3 Typically, such patients have symptoms at rest or with minimal exertion and cannot perform many activities of …

Left ventricular assist devices (LVADs) are approved for both a bridge to cardiac transplantation as well as for destination therapy. Most patients with LVADs have implantable cardioverter-defibrillators (ICDs) and several interactions between LVADs and ICDs have been reported. In the present case, we describe an interaction of an approved LVAD with remote telemetry of a previously implanted Sorin ICD (Sorin Group, Milan, Italy) that could not be resolved with standard shielding techniques.

growth factor. The mTOR pathway is highly active in HHV-8–infected KS cells, and mTOR inhibitors have been shown to inhibit the production as well as the effect of vascular endothelial growth factor. More recently, mTOR inhibitor was found to inhibit HHV-8 replication. Accordingly, mTOR inhibitors have been recommended for the treatment of KS lesions in transplant recipients, and a switch to mTOR inhibitor is recommended, as was done in the present patient. Successful treatment of malignancies in transplant recipients will invariably require a reduction in immunosuppression and hence the risk of allograft rejection. In our patient, the change in therapy may have triggered bronchiolitis obliterans syndrome, although the two events may be unrelated. Renal function is likely to have benefited from a reduced trough level of ciclosporin. Although the combination of mTOR inhibitor and reduced ancillary immunosuppression resulted in tumor regression, the long-term effects of this approach on the outcome of the lung allograft may be compromised and require close vigilance and follow-up.

Category: 45. Biomedical Computing/Information TechnologySession-Poster Board Number: 1135-137Authors: Salvatore Chiaramida, Matt Luff, Michael L. Bernard, John M. Toole, Adrian B. Van Bakel, Jennifer L. Peura, Ying Sun, Medical University of South Carolina, Charleston, SC, University of Rhode Island, Kingston, RI Background: Standard connection of the left ventricular assist device (LVAD) is from left ventricle (LV) to aorta (Ao). Left atrium (LA) is a possible alternative for LVAD drainage, but has not been fully characterized. In this study a computer model provides a comparison between LA and LV for LVAD drainage in terms of hemodynamic effects on the circulatory system.Methods: Computer simulations were based on an electrical analog model of the circulatory system with a continuous-flow LVAD. The connection of the LVAD is either from LV to Ao or from LA to Ao. A total of 28 nonlinear differential equations were numerically integrated to generate hemodynamic waveforms at various parts of the circulatory system.Results: Figure shows LV and LA pressure-volume loops for A) congestive heart failure, B) LVAD with LV drainage, and C) LVAD with LA drainage. In B the LVAD flow (Qlvad) is adjusted to achieve a 95% assist ratio. In C Qlvad is adjusted to achieve the same cardiac output (CO) as in B. Table summarizes hemodynamic effects in terms of CO, LV ejection fraction (EF), arterial blood pressure (BP), and pulmonary capillary wedge pressure (PCWP).Conclusions: LVAD with LA unloading has the advantage of allowing for a higher LV systolic function, thereby achieving the same level of cardiac output with a lower assist ratio.