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Evaluation of micro-emboli in a patient with ventricular assist device support with hemolysis

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  • Artificial Heart (Clinical)
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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.

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Acknowledgments

We thank Hiroshi Nishioka, Akira Hatanaka, Megumi Komiyama, Rieko Sakai, Emiko Fujiwara, Chiyo Fujikawa, Eri Miyoshi, Ai Nagayo, Nobuaki Konishi, Shiho Tsuboi, and Yumiko Hori for their role in patient care.

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

    Osamu Seguchi, Keiko Shimamoto, Takuma Sato, Seiko Nakajima, Haruki Sunami, Kensuke Kuroda, Takamasa Sato, Takuya Watanabe, Masanobu Yanase & Takeshi Nakatani

  2. Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, Suita, Japan

    Kozue Saito, Kazuki Fukuma & Kazuyuki Nagatsuka

  3. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan

    Hiroki Hata, Tomoyuki Fujita & Junjiro Kobayashi

Authors
  1. Osamu Seguchi
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  2. Kozue Saito
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  3. Kazuki Fukuma
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  4. Keiko Shimamoto
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  5. Takuma Sato
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  6. Seiko Nakajima
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  7. Haruki Sunami
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  8. Kensuke Kuroda
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  9. Takamasa Sato
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  11. Hiroki Hata
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  12. Masanobu Yanase
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  13. Tomoyuki Fujita
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  14. Junjiro Kobayashi
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  15. Kazuyuki Nagatsuka
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  16. Takeshi Nakatani
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Corresponding author

Correspondence to Osamu Seguchi.

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Seguchi, O., Saito, K., Fukuma, K. et al. Evaluation of micro-emboli in a patient with ventricular assist device support with hemolysis. J Artif Organs 18, 276–279 (2015). https://doi.org/10.1007/s10047-015-0832-2

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  • DOI: https://doi.org/10.1007/s10047-015-0832-2

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