Effectiveness of Sildenafil for Right Ventricular Failure after Left Ventricular Assisted Device Implantation: a Case Report

Introduction: Refractory right ventricular failure (RVF) after the implantation of left ventricular assisted device (LVAD) is induced with increased morbidity and mortality. Case: A 23- year-old man with severe heart failure was hospitalized due to dilated cardiomyopathy with severe heart failure. Despite intensive care including intra-aortic balloon pumping and intravenous dobutamine, his cardiac function declined progressively and we decided to implant a LVAD as a bridge to transplantation. Three months after implantation, RVF was suspected due to the presence of leg edema and pleural effusion. His echocardiography showed dysfunction of both ventricles and moderate tricuspid regurgitation. Cardiac catheterization showed his mean right atrial pressure; 18 mmHg, mean pulmonary arterial pressure; 31 mmHg, pulmonary vascular resistance (PVR); 2.7 Wood units, cardiac index; 1.6 L/min/m2. Although we started administering dobutamine and milrinone and raising the pump speed against worsening RVF, his symptoms did not improve. Furthermore, a PDE5 inhibitor, sildenafil was tried to treat RVF. Although his PVR was not high, his symptoms improved notably. Conclusions: We report a case in whom the administration of sildenafil for RVF after LVAD implantation resolved symptoms despite PVR not being high. Potent pulmonary hypertension drugs may enable treatment of RVF after LVAD even if PVR is normal.