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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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  • Artificial Heart (Clinical)
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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 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.

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Conflict of interest

The authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Transplantation, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan

    Seiko Nakajima, Osamu Seguchi, Yoshihiro Murata, Michinari Hieda, Takuya Watanabe, Takuma Sato, Haruki Sunami, Masanobu Yanase & Takeshi Nakatani

  2. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan

    Takafumi Yamane

  3. Department of Adult Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan

    Tomoyuki Fujita, Hiroki Hata & Junjiro Kobayashi

Authors
  1. Seiko Nakajima
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  2. Osamu Seguchi
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  3. Yoshihiro Murata
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  4. Tomoyuki Fujita
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  5. Hiroki Hata
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  6. Takafumi Yamane
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  7. Michinari Hieda
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  8. Takuya Watanabe
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  9. Takuma Sato
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  10. Haruki Sunami
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  11. Masanobu Yanase
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  12. Junjiro Kobayashi
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  13. Takeshi Nakatani
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Corresponding author

Correspondence to Osamu Seguchi.

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Nakajima, S., Seguchi, O., Murata, Y. et al. Left coronary artery occlusion caused by a large thrombus on the left coronary cusp in a patient with a continuous-flow ventricular assist device. J Artif Organs 17, 197–201 (2014). https://doi.org/10.1007/s10047-014-0758-0

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  • DOI: https://doi.org/10.1007/s10047-014-0758-0

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