Document Detail


Left coronary artery occlusion caused by a large thrombus on the left coronary cusp in a patient with a continuous-flow ventricular assist device.
MedLine Citation:
PMID:  24509915     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Despite continual improvements in ventricular assist device (VAD) therapy, various clinical issues are emerging. Importantly, various types of thromboembolic complications have been reported to date. Recently, we encountered a rare continuous-flow VAD-related thromboembolic event that resulted in acute myocardial infarction. A 26-year-old female who just underwent HeartMate II(®) VAD implantation suddenly developed widespread anterolateral myocardial infarction on postoperative day 16. Echocardiography and aortography revealed a large thrombus on the left coronary cusp of the aortic valve that almost completely occluded the left coronary ostium. After VAD implantation, her aortic valve did not open, even at relatively low pump speeds; this was thought to be one of the causes for thrombus formation. Continuous suction of blood from the left ventricle and non-pulsatile flow into the ascending aorta resulted in a continuously closed aortic valve and stagnation of blood in the coronary cusp. Furthermore, both small body size (body surface area <1.3 m(2)) and postoperative right ventricular failure may have exacerbated blood stagnation and thrombus formation in this patient. We should have adjusted the anticoagulation and antiplatelet therapy protocols based on the patient's condition. She underwent off-pump coronary artery bypass surgery and remained in clinically stable condition afterwards.
Authors:
Seiko Nakajima; Osamu Seguchi; Yoshihiro Murata; Tomoyuki Fujita; Hiroki Hata; Takafumi Yamane; Michinari Hieda; Takuya Watanabe; Takuma Sato; Haruki Sunami; Masanobu Yanase; Junjiro Kobayashi; Takeshi Nakatani
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-2-8
Journal Detail:
Title:  Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs     Volume:  -     ISSN:  1619-0904     ISO Abbreviation:  J Artif Organs     Publication Date:  2014 Feb 
Date Detail:
Created Date:  2014-2-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9815648     Medline TA:  J Artif Organs     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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