Direct thrombolytic therapy for intraventricular thrombosis in patients with the Jarvik 2000 left ventricular assist device.
One of the complications that can occur with continuous, axial-flow left ventricular assist devices (LVADs) is thrombosis within the left ventricle, adjacent to the device's inflow conduit, which may cause inflow obstruction and recurrent heart failure. We describe 2 cases in which we used a catheter to continuously infuse recombinant tissue plasminogen activator (tPA) into the left ventricle until signs of successful thrombolysis was achieved. By monitoring the result and administering only as much tPA as necessary to achieve thrombolysis, we were able to successfully lyse the obstructing thrombus with a minimal dose of tPA without causing any significant bleeding problems. This technique may be useful for managing this potentially serious complication while minimizing the risk of treatment.
Delgado
Reynolds
R
Cardiopulmonary Transplant Service and the Cardiovascular Research Laboratories of the Texas Heart Institute, Houston, TX 77030, USA. rdelgado@pol.net
Frazier
O H
OH
Myers
Timothy J
TJ
Gregoric
Igor D
ID
Robertson
Kimberly
K
Shah
Nyma A
NA
Kar
Biswajit
B
D006328:Cardiac Catheterization; D009202:Cardiomyopathies / Q000628:therapy; D004452:Echocardiography; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006333:Heart Failure / Q000628:therapy; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000628:therapy; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000209:etiology / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator