Intracranial Mycotic Aneurysm in a Left Ventricular Assist Device Patient: A Complication to Avoid.

Pavida Pachariyanon,Nandini Nair,Arunee T Motes

doi:10.7759/cureus.12401

Abstract

In the current era of the increasing use of left ventricular assist devices (LVADs) as a bridge to transplant or destination therapy, early diagnosis and therapy of complications are imperative to provide a better quality of life and improve outcomes. This case illustrates how superficial infections can lead to drastic complications in the setting of LVADs. The lack of signs and symptoms of systemic inflammatory response could be explained by cellular immunity impairment in patients on LVAD support. The formation of aneurysms is enhanced in the LVAD population due to altered hemodynamic physiology. It is possible that the combination of impaired cellular immunity and altered hemodynamics of the present-day continuous flow LVADS increases the risk of mycotic aneurysm formation and rupture in patients infected with less virulent organisms.

Highlights

Left ventricular assist devices (LVADs) have been increasingly used as a bridge to transplant and for destination therapy in end-stage heart failure patients
It is possible that the combination of impaired cellular immunity and altered hemodynamics of the present-day continuous flow LVADS increases the risk of mycotic aneurysm formation and rupture in patients infected with less virulent organisms
We present here a rare case of a ruptured intracranial mycotic aneurysm secondary to Staphylococcus epidermidis (S. epidermidis) bacteremia in the setting of a superficial driveline infection

Summary

Introduction

Left ventricular assist devices (LVADs) have been increasingly used as a bridge to transplant and for destination therapy in end-stage heart failure patients. A 53-year-old African American male with non-ischemic cardiomyopathy underwent Heartmate II LVAD (Abbott Laboratories, Chicago, Illinois) implantation as destination therapy He presented with intermittent yellowish discharge around the driveline exit site approximately 140 days post-implantation. CT angiography of the head and neck showed a 10.7 x 9.6 x 7.6 mm bilobed-shaped fusiform aneurysm arising from the distal aspect of the posterior trunk of the left middle cerebral artery (Figure 2). His international normalized ratio was 1.25 while partial thromboplastin activation time was 34 seconds at the time.

Discussion

Findings

Conclusions

Disclosures