Left ventricular pseudoaneurysm as a complication of LVAD explant

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Left ventricular pseudoaneurysm arising as a complication of LVAD explant (n=1). Intervention: Computed tomographic angiography (CTA) diagnosis followed by percutaneous closure (2 Amplatzer plugs) and surgical LV apex repair via left anterior thoracotomy. Primary outcome: Successful surgical repair and patient recovery.

Q: What does this research mean for the field?

Computed tomographic angiography can rapidly identify left ventricular pseudoaneurysms caused by leaking LVAD explant closure devices, enabling timely life-saving surgical repair. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Mohanad Kurdi; Latika Baranga; Rohindeep Singh; Jinel Scott

doi:10.1016/j.radcr.2023.10.022

November 2, 2023Radiology Case ReportsOpen Access

Left ventricular pseudoaneurysm as a complication of LVAD explant

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Why the study?

LV pseudoaneurysms are rare with diverse etiologies, and familiarity with their radiologic manifestations is critical for prompt diagnosis and timely intervention.

Key Points

To describe the radiographic manifestations of a rare left ventricular pseudoaneurysm developing secondary to a leaking ventricular closure device after left ventricular assist device explantation.
Case evaluation of a 46-year-old male presenting with a 2-day history of progressive left-sided abdominal pain and a pulsatile left upper quadrant mass after prior HeartMate-II LVAD explant.
Diagnostic workup included electrocardiography, laboratory testing, and emergency computed tomographic angiography (CTA) of the aorta.
CTA demonstrated an apical left ventricular wall defect with contrast extravasation into a preperitoneal pocket compressing the left hepatic lobe and diaphragm.
The contained rupture arose due to contrast leaking around a displaced Amplatzer closure plug placed at the site of prior ventricular assist device inflow cannulation.
Following emergent transfer and surgical repair, the patient completed treatment for Staphylococcus epidermidis bacteremia and was discharged home on postoperative day 7.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 male patient, aged 46 years, with a history of nonischemic dilated cardiomyopathy and prior HeartMate-II LVAD explant, presenting with a left ventricular pseudoaneurysm and followed for 2 months postoperatively.

I

Intervention

Computed tomographic angiography (CTA) for diagnosis, followed by initial percutaneous closure using 2 Amplatzer plugs and definitive surgical repair 4 days later (cardiopulmonary bypass, left anterior thoracotomy with removal of a portion of the sixth rib, removal of previous LVAD apical connector and Amplatzer plugs, drainage of preperitoneal fluid collection, and closure of LV apex).

O

Outcome

Clinical recovery and resolution of the left ventricular pseudoaneurysm at 2 months postoperationhard clinical

Prompt CTA imaging is critical for diagnosing rare left ventricular pseudoaneurysms arising from leaking LVAD closure devices, enabling timely surgical repair of a potentially fatal complication.

Limitations

Single-patient case report
External surgical records were not available at presentation
External surgical records from prior cardiothoracic interventions were unavailable at presentation

Implication

CTA may aid rapid diagnosis of rare LVAD-related pseudoaneurysms; leaves open generalizability and optimal surveillance strategies.

Abstract

Left ventricular (LV) pseudoaneurysms are a rare disease entity associated with a multitude of etiologies. We describe the radiographic findings of an LV pseudoaneurysm arising as a complication of a leaking left ventricular assist device (LVAD) closure device. Computed tomographic angiography (CTA) imaging demonstrated an apical LV wall defect with a preperitoneal collection of extravasated contrast. A review of the patient's surgical history revealed prior LVAD placement and explant with placement of an LV closure device. Familiarity with the radiologic manifestation of LV pseudoaneurysms is critical to establish a prompt diagnosis and facilitate timely therapeutic intervention.

Discussion

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Cite This Study

Kurdi et al. (2023) conducted a case report in Left ventricular pseudoaneurysm arising as a complication of LVAD explant (n=1). Computed tomographic angiography (CTA) diagnosis followed by percutaneous closure (2 Amplatzer plugs) and surgical LV apex repair via left anterior thoracotomy was evaluated on Successful surgical repair and patient recovery.

synapsesocial.com/papers/6a734e49aa6305455eb86dc3 https://doi.org/10.1016/j.radcr.2023.10.022

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Left ventricular pseudoaneurysm as a complication of LVAD explant

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Left ventricular pseudoaneurysm as a complication of LVAD explant

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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