title: Left coronary artery occlusion caused by a large thrombus on the left coronary cusp in a patient with a continuous-flow ventricular assist device.
abstract: 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: Department of Transplantation, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors: Seiko
authors: S
authors: Nakajima
authors: Osamu
authors: O
authors: Seguchi
authors: Yoshihiro
authors: Y
authors: Murata
authors: Tomoyuki
authors: T
authors: Fujita
authors: Hiroki
authors: H
authors: Hata
authors: Takafumi
authors: T
authors: Yamane
authors: Michinari
authors: M
authors: Hieda
authors: Takuya
authors: T
authors: Watanabe
authors: Takuma
authors: T
authors: Sato
authors: Haruki
authors: H
authors: Sunami
authors: Masanobu
authors: M
authors: Yanase
authors: Junjiro
authors: J
authors: Kobayashi
authors: Takeshi
authors: T
authors: Nakatani
mesh_terms: D000328:Adult; D001021:Aortic Valve; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000628:therapy*; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy