Non-ST elevation myocardial infarction from aortic root thrombus after LVAD placement

Aortic root thrombosis (ART) is a rare but serious complication following the placement of continuous-flow left ventricular assist devices (CF-LVAD). We present the case of a patient with idiopathic non-ischaemic cardiomyopathy who developed a non-ST elevation myocardial infarction (NSTEMI) secondary to ART after CF-LVAD placement. The patient was treated conservatively with antiplatelet therapy and increased international normalized ratio (INR) goal with resolution of thrombus on repeat imaging. ART may be an under-recognised complication in patients with CF-LVAD. Stasis of blood at the aortic root in patients with CF-LVAD may contribute to the development of ART. Management of these patients presenting with myocardial infarction should be individualised by using a multidisciplinary team approach. Our case report suggests conservative management of NSTEMI secondary to ART in patients with CF-LVAD with antiplatelet therapy and an increased INR goal as a reasonable treatment approach.