Left coronary artery occlusion caused by a large thrombus on the left coronary cusp in a patient with a continuous-flow ventricular assist device

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• 作者：Seiko Nakajima (1)
  Osamu Seguchi (1)
  Yoshihiro Murata (1)
  Tomoyuki Fujita (3)
  Hiroki Hata (3)
  Takafumi Yamane (2)
  Michinari Hieda (1)
  Takuya Watanabe (1)
  Takuma Sato (1)
  Haruki Sunami (1)
  Masanobu Yanase (1)
  Junjiro Kobayashi (3)
  Takeshi Nakatani (1)
  
• 关键词：Ventricular assist device ; Myocardial infarction ; Thrombus ; Off ; pump coronary artery bypass surgery
• 刊名：Journal of Artificial Organs
• 出版年：2014
• 出版时间：June 2014
• 年：2014
• 卷：17
• 期：2
• 页码：197-201
• 全文大小：
• 参考文献：1. Pagani FD, Miller LW, Russell SD, Aaronson KD, John R, Boyle AJ, Conte JV, Bogaev RC, MacGillivray TE, Naka Y, Mancini D, Massey HT, Chen L, Klodell CT, Aranda JM, Moazami N, Ewald GA, Farrar DJ, Frazier OH. HeartMate II investigators. Extended mechanical circulatory support with a continuous-flow rotary left ventricular assist device. J Am Coll Cardiol. 2009;54:312-1. CrossRef
  2. Slaughter, Rogers LG, Milano CA, Russell SD, Conte JV, Feldman D, Sun B, Tatooles AJ, Delgado RM 3rd, Long JW, Wozniak TC, Ghumman W, Farrar DJ, Frazier OH. HeartMate II investigators. Advanced heart failure treated with continuous-flow left ventricular assist device. N Eng J Med. 2009;361:2241-1. CrossRef
  3. John R, Kamdar F, Liao K, Colvin-Adams M, Miller L, Joyce L, Boyle A. Low thromboembolic risk for patients with the Heartmate II left ventricular assist device. J Thorac Cardiovasc Surg. 2008;136:1318-3. CrossRef
  4. Boyle AJ, Russel SD, Teuteberg JJ, Slaughter MS, Moazami N, Pagani FD, Frazier OH, Heatley G, Farrar DJ, John R. Low thromboembolism and pump thrombosis with the Heartmate II left ventricular assist device: analysis of outpatient anti-coagulation. J Heart Lung Transplant. 2009;28:881-. CrossRef
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  10. Fujita T, Kobayashi J, Hata H, Seguchi O, Sato T, Yanase M, Murata Y, Sunami H, Nakatani S. Aortic valve closure for rapidly deteriorated aortic insufficiency after continuous flow left ventricular assist device implantation. J Artif Organs. 2013;16:98-00. CrossRef
  
• 作者单位：Seiko Nakajima (1)
  Osamu Seguchi (1)
  Yoshihiro Murata (1)
  Tomoyuki Fujita (3)
  Hiroki Hata (3)
  Takafumi Yamane (2)
  Michinari Hieda (1)
  Takuya Watanabe (1)
  Takuma Sato (1)
  Haruki Sunami (1)
  Masanobu Yanase (1)
  Junjiro Kobayashi (3)
  Takeshi Nakatani (1)
  
  1. Department of Transplantation, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
  3. Department of Adult Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
  2. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
  
• ISSN：1619-0904

文摘

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?m2) 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.