Small bowel fistula and its impact: incorrect placement of left ventricular assist device cannulas leads to severe intestinal complications.
A young man presented with a chronic abdominal dermal irritation 4 years after implantation of a left ventricular assist device (LVAD; Berlin heart excor). The LVAD was needed because of end-stage heart failure following a chronic parvovirus B19 Infection. The implantation of mechanical circulatory support systems (MCS) has nowadays become an accepted treatment modality for patients with end-stage heart failure. Recent literature shows several intestinal complications related to MCS, but no case presents the development of a small bowel fistula to the jejunum, transversal colon and stomach. We present a case of inaccurate placement of Berlin heart excor LVAD cannulas and its impact. This case emphasises the importance of correct placement of VAD cannulas to achieve an optimal long-term result. After surgical treatment the postoperative course was prolonged because of increasing peritonitis probably based on ongoing intraperitoneal chronic contamination with intestinal germs. The patient unfortunately deceased.
Cardiovascular Surgery Department, German Heart Institute Berlin, Berlin, Germany. kdrylmz@gmx.de
Kadir
K
Yilmaz
Heinrich
H
Erpenbeck
Thorsten
T
Drews
Roland
R
Hetzer
D000328:Adult; D017809:Fatal Outcome; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology* / Q000601:surgery; D007421:Intestine, Small; D008297:Male