Early Aortic Root and Left Main Coronary Artery Thrombosis after Left Ventricular Assist Device Implantation

Abstract

We describe a case of 39 years old male, underwent continuous flow LVAD implantation (HeartWare) HVAD as destination therapy (DT) for severe left ventricular dysfunction, moderate right ventricular dysfunction and severe pulmonary hypertension, presented 3 rd day post-operatively with polymorphic ventricular tachycardia (VT storm) alternating with VF before aborting to bradycardia and complete heart block. Coronary angiography revealed a big LM coronary artery thrombus extended distally to LCX and LAD arteries and pedunculating into the aortic root proximally, despite full coverage with antiplatelet and anticoagulant therapy. In conclusion, the " take-home message " is: we should be " thrombus minded " for early diagnosis and management of post LVAD implantation aortic root and LM coronary artery thrombosis and it is necessary in improving post-operative outcome. Also, high risk surgical interference in such sick patients can be avoided by early interventional management.