Journal of Artificial Organs

, Volume 17, Issue 2, pp 197–201 | Cite as

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

  • Seiko Nakajima
  • Osamu Seguchi
  • Yoshihiro Murata
  • Tomoyuki Fujita
  • Hiroki Hata
  • Takafumi Yamane
  • Michinari Hieda
  • Takuya Watanabe
  • Takuma Sato
  • Haruki Sunami
  • Masanobu Yanase
  • Junjiro Kobayashi
  • Takeshi Nakatani
Case Report Artificial Heart (Clinical)

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.

Keywords

Ventricular assist device Myocardial infarction Thrombus Off-pump coronary artery bypass surgery 

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Copyright information

© The Japanese Society for Artificial Organs 2014

Authors and Affiliations

  • 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. 1.Department of TransplantationNational Cerebral and Cardiovascular CenterOsakaJapan
  2. 2.Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
  3. 3.Department of Adult Cardiac SurgeryNational Cerebral and Cardiovascular CenterOsakaJapan

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