Atypical presentation of an apical pseudoaneurysm in a patient on prolonged left ventricular mechanical support

Interactive Cardiovascular and Thoracic Surgery
Taketoshi MaedaRyuji Tominaga

Abstract

Prolonged support with left ventricular assist system (LVAS) increases the risk of device-related infection. We experienced a rare complication of LVAS: an infectious aneurysm at the apical cannula, which appeared with atypical presentation. A 27-year-old male, who developed acute aggravation of dilated cardiomyopathy, was placed on extra-corporeal type LVAS. Six months later, the patient suffered from methicillin-resistant Staphylococcus aureus (MRSA) sepsis that lasted for as long as three months despite intensive antibiotic therapy. At 17 months after the implantation, he presented with obstructive ileus. Monthly assessment with transthoracic echocardiography (TTE) did not document any abnormalities around the ventricle. A contrast computed tomographic (CT) scan revealed a huge apical aneurysm protruding into the preperitoneal space. The aneurysm oppressed the transverse colon, resulting in obstructive ileus. Aneurysmectomy was carried out and MRSA was identified from the resected tissue. We reached the precise diagnosis with a CT-scan, although routine assessment with TTE failed to reveal abnormalities. Knowledge of this complication is essential in LVAS management. This is certainly rare, but possibly occurs in all the pat...Continue Reading

References

Nov 6, 1998·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·A S CurtisJ F Antaki
Jun 23, 2006·The Lancet Infectious Diseases·Rachel J GordonFranklin D Lowy
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Jun 6, 2009·Circulation Journal : Official Journal of the Japanese Circulation Society·Takeshi Nakatani

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Citations

Apr 12, 2014·Journal of Artificial Organs : the Official Journal of the Japanese Society for Artificial Organs·Tomoki UshijimaRyuji Tominaga
Jan 17, 2013·Circulation. Heart Failure·Asvin M GanapathiG Chad Hughes
May 17, 2012·Circulation. Heart Failure·Ashley R MoserBethany A Austin
Nov 3, 2020·Journal of Vascular Surgery Cases and Innovative Techniques·Mark D BalceniukMichael C Stoner

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