Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2014;67:322 - Vol. 67 Num.04 DOI: 10.1016/j.rec.2013.08.013

A Serious Complication in a Patient With a Ventricular Assist Device

Francisco J. Hernández-Pérez a, Raúl J. Burgos-Lázaro b, Manuel F. Gómez-Bueno a,

a Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
b Servicio de Cirugía Cardiovascular, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain

Article

We report the case of a 47-year-old man with end-stage ischemic heart disease who underwent implantation of a Berlin Heart EXCOR® biventricular assist device (VAD) as a bridge to transplantation (Figure 1). He received oral anticoagulation and dual antiplatelet therapy with acetylsalicylic acid and clopidogrel, according to the standard protocol until, 1 month later, he had a hemorrhagic stroke that left no sequelae. Therefore, the decision was made to discontinue the antiplatelet therapy and to treat the patient with acenocoumarol alone.

Figure 1.

Three months later, he came to the emergency service because of a warning from the VAD that indicated low flow in the system. He had an international normalized ratio (INR) of 2.6. Inspection of the left VAD (Figure 2 and video clip [supplementary material]) revealed a moving shadow (σ) associated with a thrombus that grew rapidly (¿) within the blood chamber, in addition to an abnormal expansion of the outer membrane during systole (Figure 2). As we suspected rupture of 1 of the membranes that separate the 2 chambers (blood and air) and because of the risk of systemic embolization of the thrombus, the left VAD cannulas were rapidly clamped and the flow in the right VAD was reduced to prevent acute pulmonary edema. The malfunctioning VAD was replaced, (Figure 3) and rupture of the inner membrane (*) of the explanted device and the presence of a large associated thrombus (δ) were confirmed. The outcome of this replacement was favorable and the patient received a transplant several weeks later.

Figure 2.

Figure 3.

Thrombotic complications associated with VAD are relatively frequent and potentially fatal events. In this case, early identification of the problem and urgent intervention allowed successful replacement of the device and subsequent transplantation.

SUPPLEMENTARY DATA

Video

Corresponding author:. mgomezbueno@secardiologia.es

1885-5857/© 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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