Aortic root thrombus causing non-ST elevation myocardial infarction after left ventricular assist device. (July 2023)

• Record Type: Journal Article
• Authors: Kallur, Akhil S; Bien-Aime, Fred; Sallam, Tariq; Jawaid, Yasir; Zaaqoq, Akram M
• Is Part Of: Perfusion. Volume 38:Number 5(2023)
• Page Start: 1095
• Page End: 1097
• Publication Date: 2023-07
• Subjects: left ventricular assist device -- left ventricular assist device -- non-ST elevation myocardial infarction -- aortic root thrombus -- coronary angiography; Perfusion (Physiology) -- Periodicals; Blood -- Circulation, Artificial -- Periodicals; Heart -- Surgery -- Periodicals; Extracorporeal Circulation -- Periodicals; Perfusion -- Periodicals; Circulation extracorporelle -- Périodiques; Perfusion -- Périodiques; 617.41
• DOI: 10.1177/02676591221096228
• Languages: English
• ISSNs: 0267-6591

Abstract

A 61-year-old male presented with a history of ischemic cardiomyopathy requiring left ventricular assist device (LVAD) implantation 9 months prior to presentation. The patient was on aspirin and warfarin as part of his LVAD management. The patient had chest pain and was found to have non-ST elevation myocardial infarction. Despite being on warfarin, a subtherapeutic international normalized ratio of 1.6 was measured on admission. Lactate dehydrogenase was 694 U/L (12–146) and high-sensitivity troponin peaked at 47, 093 ng/L. Left heart catheterization revealed an extensive aortic root thrombus (AT). AT is an uncommon cause of thromboembolic events in long-term LVAD patients. Thrombotic events in LVAD patients are pump thrombosis, cerebrovascular accidents, heparin-induced thrombocytopenia, and rarely, AT. There is no well-described management of such a rare complication. In our report, we suggest a multidisciplinary approach and consideration of conservative treatment of these patients.