Published online Apr 28, 2016. doi: 10.4329/wjr.v8.i4.428
Peer-review started: November 9, 2015
First decision: December 7, 2015
Revised: January 21, 2016
Accepted: February 14, 2016
Article in press: February 16, 2016
Published online: April 28, 2016
The association between continuous-flow left ventricular assist devices (CF-LVADs) and gastrointestinal (GI) bleeding from angiodysplasia is well recognized. However, the association between continuous-flow biventricular assist devices (CF-BIVADs) and bleeding angiodysplasia is less understood. We report a case of GI bleeding from a patient with a CF-BIVAD. The location of GI bleeding was identified by nuclear red blood cell bleeding scan. The vascular malformation leading to the bleed was identified and localized on angiography and then by pathology. The intensity of bleeding, reflected by number of units of packed red blood cells needed for normalization of hemoglobin, as well as the time to onset of bleeding after transplantation, are similar to that seen in the literature for CF-LVADs and pulsatile BIVADs. While angiography only detected a dilated late draining vein, pathology demonstrated the presence of both arterial and venous dilation in the submucosa, vascular abnormalities characteristic of a late arteriovenous malformation.
Core tip: Gastrointestinal (GI) bleeding from angiodysplasia is a recognized complication in patients with continuous-flow left ventricular assist devices. The pathogenesis of the association, including coagulopathy and mechanics related to blood flow through the device, remains under investigation. We review a case of GI bleeding in a patient with a continuous-flow biventricular assist device.