TY - JOUR
T1 - Evaluation of micro-emboli in a patient with ventricular assist device support with hemolysis
AU - Seguchi, Osamu
AU - Saito, Kozue
AU - Fukuma, Kazuki
AU - Shimamoto, Keiko
AU - Sato, Takuma
AU - Nakajima, Seiko
AU - Sunami, Haruki
AU - Kuroda, Kensuke
AU - Sato, Takamasa
AU - Watanabe, Takuya
AU - Hata, Hiroki
AU - Yanase, Masanobu
AU - Fujita, Tomoyuki
AU - Kobayashi, Junjiro
AU - Nagatsuka, Kazuyuki
AU - Nakatani, Takeshi
N1 - Publisher Copyright:
© 2015, The Japanese Society for Artificial Organs.
PY - 2015/9/4
Y1 - 2015/9/4
N2 - The clinical relevance of transcranial Doppler (TCD) detection of micro-embolic signals (MES) in patients with ventricular assist devices (VADs) has been described. However, all of the previous studies concerning TCD in patients with VADs were conducted in patients with old devices; the clinical relevance of TCD in patients with newer devices has not been fully elucidated. We recently encountered a patient with a continuous-flow VAD with hemolysis. TCD monitoring was useful for the direct evaluation of micro-emboli in this patient. A 50-year-old male who underwent HeartMate II® VAD (Thoratec Corporation; Pleasanton, CA) implantation with a diagnosis of ischemic cardiomyopathy 15 months prior was admitted to our institution because of findings suggestive of hemolysis, such as elevated lactate dehydrogenase (LDH) and total bilirubin. Unfractionated heparin was started after admission and hemolysis gradually improved. On admission, TCD detected 146 MES during 30 min of monitoring. During the hospital course, the MES count decreased to 20 signals on hospital day 4 and further decreased to 2 signals on hospital day 15 along with decreases in LDH and total bilirubin. Since hemolysis in VAD patients is thought to be associated with thromboembolic outcomes, MES detected by TCD indicate subclinical micro-emboli. TCD monitoring may be useful for assessing the risk of thromboembolic events in newer continuous-flow VAD patients through direct visualization of micro-emboli.
AB - The clinical relevance of transcranial Doppler (TCD) detection of micro-embolic signals (MES) in patients with ventricular assist devices (VADs) has been described. However, all of the previous studies concerning TCD in patients with VADs were conducted in patients with old devices; the clinical relevance of TCD in patients with newer devices has not been fully elucidated. We recently encountered a patient with a continuous-flow VAD with hemolysis. TCD monitoring was useful for the direct evaluation of micro-emboli in this patient. A 50-year-old male who underwent HeartMate II® VAD (Thoratec Corporation; Pleasanton, CA) implantation with a diagnosis of ischemic cardiomyopathy 15 months prior was admitted to our institution because of findings suggestive of hemolysis, such as elevated lactate dehydrogenase (LDH) and total bilirubin. Unfractionated heparin was started after admission and hemolysis gradually improved. On admission, TCD detected 146 MES during 30 min of monitoring. During the hospital course, the MES count decreased to 20 signals on hospital day 4 and further decreased to 2 signals on hospital day 15 along with decreases in LDH and total bilirubin. Since hemolysis in VAD patients is thought to be associated with thromboembolic outcomes, MES detected by TCD indicate subclinical micro-emboli. TCD monitoring may be useful for assessing the risk of thromboembolic events in newer continuous-flow VAD patients through direct visualization of micro-emboli.
UR - http://www.scopus.com/inward/record.url?scp=84940724369&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84940724369&partnerID=8YFLogxK
U2 - 10.1007/s10047-015-0832-2
DO - 10.1007/s10047-015-0832-2
M3 - Article
C2 - 25796205
AN - SCOPUS:84940724369
SN - 1434-7229
VL - 18
SP - 276
EP - 279
JO - Journal of Artificial Organs
JF - Journal of Artificial Organs
IS - 3
ER -