Pneumopericardium suggesting left ventricular assist device-related gastrointestinal complication
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CASE REPORT Artificial Heart (Clinical)
Pneumopericardium suggesting left ventricular assist device‑related gastrointestinal complication Tomoki Ushijima1 · Yoshihisa Tanoue1 · Kazuto Hirayama1 · Akira Shiose1 Received: 20 August 2019 / Accepted: 7 January 2020 © The Japanese Society for Artificial Organs 2020
Abstract We report an uncommon case of ventricular assist device-related infection and resultant fistula formation into the gastrointestinal tract. A 69-year-old man, who had undergone implantation of a HeartMate II 1 year earlier secondary to ischemic cardiomyopathy, presented to our hospital with a high fever. Computed tomography showed unusual gas collection around the heart apex (i.e., pneumopericardium), which had not been detected before. The patient developed sudden melena with fresh blood without abdominal symptoms 1 month after beginning antibiotic therapy. Emergent colonoscopy showed that the HeartMate II strain relief of the inflow conduit had penetrated the transverse colon. We immediately performed laparoscopyassisted left-sided hemicolectomy and found intraoperatively that a fistula had formed between the splenic flexure and the pericardial cavity. Subsequently, the HeartMate II system was totally explanted and replaced with an Impella 5.0 for alternative hemodynamic support. In our patient, pneumopericardium might have been an early sign of a hidden gastrointestinal complication. Our experience is a caution for clinicians who manage patients with ventricular assist device support via the apex. Keywords Ventricular assist device · Gastrointestinal complication · Infection
Introduction Ventricular assist devices (VADs) are the primary treatment, as a bridge to transplant or destination therapy, in patients with end-stage heart failure. There is no doubt regarding the impact of VADs on survival and patients’ quality of life, but the frequency of VAD-related complications increases with longer support periods. In particular, VAD-related infections, including driveline and pump pocket infections, remain a serious problem. Some infections can be intractable, and we often struggle to treat patients with such severe complications. Chronic infections may lead to cerebral vascular accidents and gastrointestinal (GI) bleeding. We report
* Tomoki Ushijima [email protected]‑u.ac.jp * Akira Shiose [email protected]‑u.ac.jp 1
Department of Cardiovascular Surgery, Kyushu University Hospital, 3‑1‑1 Maidashi, Higashi‑ku, Fukuoka 812‑8582, Japan
our uncommon experience of a patient with VAD-related infection and resultant fistula formation into the GI tract.
Case report A 69-year-old man who had undergone implantation of a HeartMate II (HM2, Abbott, Chicago, IL, USA) left ventricular assist device (LVAD) 1 year earlier secondary to ischemic cardiomyopathy presented to our hospital with a high fever. The patient had experienced episodes of suspected pump pocket infection and transient bacteremia during the 1-year follow-up after the HM2 implantation. Computed tomography showed unusual gas
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