HeartNet cardiac restraint device

Case contributed by Dr Francis Deng

Presentation

Heart failure, pre-transplant evaluation.

Patient Data

Age: 50 years
Gender: Male
X-ray

A HeartNet cardiac restraint device encircles the heart, which is enlarged. A left-sided cardiac resynchronization therapy defibrillator (CRT-D) device has two leads terminating in the right ventricle and one in a cardiac vein. Multiple electrocardiographic leads project over the thorax.

The lungs demonstrate mild interstitial pulmonary edema. Patchy airspace opacities in both lower lungs may represent atelectasis versus pneumonia or aspiration.

X-ray

Zoomed image showing the HeartNet cardiac restraint device. 

X-ray

There has been interval placement of a left ventricular assist device. Also noted are an endotracheal tube, multiple mediastinal/pericardial tubes, mediastinal surgical sponges, a nasogastric tube, a pulmonary artery catheter, and a cardiac implantable electronic device.

A pericardial effusion is best seen at the left border of the cardiac silhouette projecting beyond the HeartNet cardiac restraint device.

The lungs demonstrates moderate interstitial pulmonary edema.

Case Discussion

The HeartNet (Paracor Medical) was an experimental device that aimed at improving outcomes in heart failure but failed to show significant benefit in a randomized clinical trial.1 This patient with dilated cardiomyopathy eventually required advanced heart failure therapy (left ventricular assist device as bridge to transplant).

The HeartNet device is placed via minithoracotomy into the intrapericardial space over the cardiac apex. Notice the lack of sternotomy fixation wires. Knowledge of the positioning and elastic property of this device is useful to distinguish cardiac enlargement from pericardial effusion. The former results in an enlarged cardiac silhouette with the cardiac restraint device on the outer edge, whereas the latter would result in the cardiac silhouette projecting beyond the circumference of the device.

As an aside, note should be made of the malpositioned cardiac device lead; specifically, the right atrial lead has been displaced into the right ventricle. Because the atrial lead is unable to sense or pace atrial impulses in such a configuration, the electrophysiologist must reprogram the device to VVI mode (ventricular sensing, ventricular pacing) to avoid malfunction.

Disclosure: I, Francis Deng, have no actual or potential ethical or financial conflict of interest in relation to this device. This case is not intended to be a personal endorsement or recommendation of this product.

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Case information

rID: 63175
Published: 18th Sep 2018
Last edited: 14th Aug 2019
System: Chest, Cardiac
Inclusion in quiz mode: Included
Institution: Massachusetts General Hospital

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