title: Implantation of left ventricular assist device complicated by undiagnosed thrombophilia.
abstract: A patient with dilated cardiomyopathy and no history of thromboembolic events received a surgically implanted axial-flow left ventricular assist device. After implantation, transesophageal echocardiography revealed a giant thrombus on the lateral and anterior aspects of the left ventricle. The inflow cannula inserted through the apex of the left ventricle was not obstructed, and the device generated satisfactory blood flow. Laboratory screening for thrombophilia showed protein S deficiency, heterozygous factor V Leiden mutation, and heterozygous MTHFR C667T mutation. During the entire duration of circulatory support, no significant suction events were detected, and the patient was listed for heart transplantation. Ventricular assist device implantation can unmask previously undiagnosed thrombophilia; therefore, it should be necessary to identify thrombophilic patients before cardiac support implantation.
authors.affiliation: Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, 140 21 Prague 4, Czech Republic. onsz@medicon.cz
authors.forename: Ondrej
authors.initials: O
authors.lastname: Szarszoi
authors.forename: Jiri
authors.initials: J
authors.lastname: Maly
authors.forename: Daniel
authors.initials: D
authors.lastname: Turek
authors.forename: Marian
authors.initials: M
authors.lastname: Urban
authors.forename: Ivo
authors.initials: I
authors.lastname: Skalsky
authors.forename: Hynek
authors.initials: H
authors.lastname: Riha
authors.forename: Jana
authors.initials: J
authors.lastname: Maluskova
authors.forename: Jan
authors.initials: J
authors.lastname: Pirk
authors.forename: Ivan
authors.initials: I
authors.lastname: Netuka
mesh_terms: D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000503:physiopathology; D004252:DNA Mutational Analysis; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D017548:Echocardiography, Transesophageal; D005165:Factor V / Q000235:genetics; D017809:Fatal Outcome; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing / Q000379:methods; D006331:Heart Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000235:genetics; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics; D008875:Middle Aged; D009154:Mutation; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000209:etiology; D018455:Protein S Deficiency / Q000150:complications / Q000175:diagnosis / Q000235:genetics; D013318:Stroke Volume; D019851:Thrombophilia / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000235:genetics; D013927:Thrombosis / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000235:genetics; D016277:Ventricular Function, Left
chemical_list: C095381:factor V Leiden; D005165:Factor V; C573423:MTHFR protein, human; D042965:Methylenetetrahydrofolate Reductase (NADPH2)
keywords: Anticoagulants/therapeutic use; blood coagulation disorders/complications; factor V Leiden; factor V/genetics; left ventricular assist device; perioperative care; postoperative complications; thrombophilia/genetics; thrombus/etiology/prevention & control