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Aortic root thrombus causing non-ST elevation myocardial infarction after left ventricular assist device

Akhil S Kallur1, Fred Bien-Aime1, Tariq Sallam1

  • 1Internal Medicine, MedStar Washington Hospital Center, Washington, D.C., USA.

Perfusion
|April 20, 2022
PubMed

Insights

A rare aortic root thrombus (AT) complication occurred in a patient with a left ventricular assist device (LVAD). This case highlights the need for multidisciplinary management of such rare thromboembolic events in LVAD patients.

Area of Science:

  • Cardiology
  • Medical Devices

Background:

  • Left ventricular assist devices (LVADs) are crucial for managing advanced heart failure.
  • Patients with LVADs require anticoagulation to prevent thrombotic complications.
  • Ischemic cardiomyopathy is a common indication for LVAD implantation.

Observation:

  • A 61-year-old male with a history of ischemic cardiomyopathy and LVAD presented with non-ST elevation myocardial infarction.
  • Despite warfarin therapy, the patient had a subtherapeutic INR of 1.6.
  • Left heart catheterization revealed an extensive aortic root thrombus (AT).

Findings:

  • Aortic root thrombus (AT) is an uncommon cause of thromboembolic events in long-term LVAD patients.
  • Thrombotic events in LVAD patients include pump thrombosis, cerebrovascular accidents, and heparin-induced thrombocytopenia.
  • This case presents a rare instance of AT in an LVAD patient on anticoagulation.

Implications:

  • Management strategies for AT in LVAD patients are not well-established.
  • A multidisciplinary approach is suggested for managing this rare complication.
  • Conservative treatment should be considered for patients with aortic root thrombus and LVAD.

Keywords:
aortic root thrombuscoronary angiographyleft ventricular assist devicenon-ST elevation myocardial infarction

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