title: Case report: atypical fungal obstruction of the left ventricular assist device outflow cannula.
abstract: We describe a very rare case of outflow cannula obstruction with fungal infectious thrombus formation. Discussion includes the etiology, diagnosis, and management of fungal infection complications related with long-term mechanical circulatory support. Left ventricular assist devices (LVADs) are increasingly used as bridge to transplant and permanent long-term therapy in the population with end-stage heart failure. Even though better clinical outcomes have been achieved with the newer-generation continuous-flow devices, infection complications are still a major risk for patients with continuous-flow LVAD implantation in long-term follow-up [Ann Thorac Surg 90:1270-1277, 2010]. Device-related infections can be categorized as driveline infections, pump-pocket infections, and LVAD-associated endocarditis [Expert Rev Med Devices 8: 627-634, 2011]. The microbiological profile is very heterogeneous; the most common pathogens are Staphylococcus, Pseudomonas, Streptococcus species, and Candida. Severe fungal infection may lead to dysfunction of the LVAD due to obstructive mass formation within the device. Due to the only anecdotal reports in the current literature, we present a very rare case of outflow fungal infectious thrombus formation leading to outflow cannula obstruction in patient with LVAD.
authors.forename: Jiri
authors.initials: J
authors.lastname: Maly
authors.forename: Ondrej
authors.initials: O
authors.lastname: Szarszoi
authors.forename: Zora
authors.initials: Z
authors.lastname: Dorazilova
authors.forename: Josef
authors.initials: J
authors.lastname: Besik
authors.affiliation: Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9 140 21 Prague 4, Prague, Czech Republic. mpok@ikem.cz.
authors.forename: Martin
authors.initials: M
authors.lastname: Pokorny
authors.forename: Tomas
authors.initials: T
authors.lastname: Kotulak
authors.forename: Ivan
authors.initials: I
authors.lastname: Netuka
mesh_terms: D057785:Catheters / Q000382:microbiology; D004696:Endocarditis / Q000382:microbiology*; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000382:microbiology*; D016459:Prosthesis-Related Infections / Q000382:microbiology*; D013927:Thrombosis / Q000382:microbiology*