Case report: atypical fungal obstruction of the left ventricular assist device outflow cannula

Jiri Maly,Ondrej Szarszoi,Martin Pokorny,Ivan Netuka,Zora Dorazilova,Tomas Kotulak,Josef Besik

doi:10.1186/1749-8090-9-40

Abstract

We describe a very rare case of outflow cannula obstruction with fungal infectious thrombus formation. Discussion includes the etiology, diagnosis, and management of fungal infection complications related with long-term mechanical circulatory support. Left ventricular assist devices (LVADs) are increasingly used as bridge to transplant and permanent long-term therapy in the population with end-stage heart failure. Even though better clinical outcomes have been achieved with the newer-generation continuous-flow devices, infection complications are still a major risk for patients with continuous-flow LVAD implantation in long-term follow-up [Ann Thorac Surg 90:1270-1277, 2010]. Device-related infections can be categorized as driveline infections, pump-pocket infections, and LVAD-associated endocarditis [Expert Rev Med Devices 8: 627-634, 2011]. The microbiological profile is very heterogeneous; the most common pathogens are Staphylococcus, Pseudomonas, Streptococcus species, and Candida. Severe fungal infection may lead to dysfunction of the LVAD due to obstructive mass formation within the device. Due to the only anecdotal reports in the current literature, we present a very rare case of outflow fungal infectious thrombus formation leading to outflow cannula obstruction in patient with LVAD.

Highlights

Left ventricular assist devices (LVADs) are increasingly used as bridge to transplant and permanent long-term therapy in the population with end-stage heart failure
Even though better clinical outcomes have been achieved with the newer-generation continuous-flow devices, infection complications are still a major risk for patients with continuous-flow LVAD implantation in long-term follow-up [1]
Case presentation A 56-year-old caucasian male with dilated cardiomyopathy was previously treated with an implantable cardiac defibrillator (ICD) as secondary prevention therapy (2002) and with a combined system of cardiac resynchronization therapy (CRT) and ICD—CRT/ICD therapy (2009) with several infectious complications, which led to explantation of the system and reimplantation of the CRT/ICD

Summary

Introduction

Left ventricular assist devices (LVADs) are increasingly used as bridge to transplant and permanent long-term therapy in the population with end-stage heart failure. Even though better clinical outcomes have been achieved with the newer-generation continuous-flow devices, infection complications are still a major risk for patients with continuous-flow LVAD implantation in long-term follow-up [1]. Severe fungal infection may lead to dysfunction of the LVAD due to obstructive mass formation within the device. During the entire duration of circulatory support, no LVAD suction events were detected, pump power consumption remained in the normal range (6 to 7.5 watts at pump speed 9,400 rpm), and the patient was listed for heart transplantation.

Results

Conclusion