title: Evaluation of micro-emboli in a patient with ventricular assist device support with hemolysis.
abstract: The clinical relevance of transcranial Doppler (TCD) detection of micro-embolic signals (MES) in patients with ventricular assist devices (VADs) has been described. However, all of the previous studies concerning TCD in patients with VADs were conducted in patients with old devices; the clinical relevance of TCD in patients with newer devices has not been fully elucidated. We recently encountered a patient with a continuous-flow VAD with hemolysis. TCD monitoring was useful for the direct evaluation of micro-emboli in this patient. A 50-year-old male who underwent HeartMate II(®) VAD (Thoratec Corporation; Pleasanton, CA) implantation with a diagnosis of ischemic cardiomyopathy 15 months prior was admitted to our institution because of findings suggestive of hemolysis, such as elevated lactate dehydrogenase (LDH) and total bilirubin. Unfractionated heparin was started after admission and hemolysis gradually improved. On admission, TCD detected 146 MES during 30 min of monitoring. During the hospital course, the MES count decreased to 20 signals on hospital day 4 and further decreased to 2 signals on hospital day 15 along with decreases in LDH and total bilirubin. Since hemolysis in VAD patients is thought to be associated with thromboembolic outcomes, MES detected by TCD indicate subclinical micro-emboli. TCD monitoring may be useful for assessing the risk of thromboembolic events in newer continuous-flow VAD patients through direct visualization of micro-emboli.
authors: Department of Transplantation, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan, seguchi.osamu.hp@mail.ncvc.go.jp.
authors: Osamu
authors: O
authors: Seguchi
authors: Kozue
authors: K
authors: Saito
authors: Kazuki
authors: K
authors: Fukuma
authors: Keiko
authors: K
authors: Shimamoto
authors: Takuma
authors: T
authors: Sato
authors: Seiko
authors: S
authors: Nakajima
authors: Haruki
authors: H
authors: Sunami
authors: Kensuke
authors: K
authors: Kuroda
authors: Takamasa
authors: T
authors: Sato
authors: Takuya
authors: T
authors: Watanabe
authors: Hiroki
authors: H
authors: Hata
authors: Masanobu
authors: M
authors: Yanase
authors: Tomoyuki
authors: T
authors: Fujita
authors: Junjiro
authors: J
authors: Kobayashi
authors: Kazuyuki
authors: K
authors: Nagatsuka
authors: Takeshi
authors: T
authors: Nakatani
mesh_terms: D009202:Cardiomyopathies / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006461:Hemolysis / Q000502:physiology*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D013923:Thromboembolism / Q000175:diagnosis* / Q000209:etiology*; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D005343:Fibrinolytic Agents; D006493:Heparin