Case Report
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2014; 2(8): 373-376
Published online Aug 16, 2014. doi: 10.12998/wjcc.v2.i8.373
Resolution of hemolysis from pump thrombus during left ventricular assist device exchange
Shinya Unai, Hitoshi Hirose, John WC Entwistle III, Louis E Samuels
Shinya Unai, Hitoshi Hirose, John WC Entwistle III, Louis E Samuels, Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, United States
Author contributions: All of the authors contributed in drafting the article, critical revision and writing the manuscript; Unai S and Hirose H collected the patient’s clinical data; all the authors approved the final version of the manuscript.
Correspondence to: Hitoshi Hirose, MD, PhD, Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, 1025 Walnut Street, Room 605, Philadelphia, PA 19107, United States. hitoshi.hirose@jefferson.edu
Telephone: +1-215-9555654 Fax: +1-215-9556010
Received: March 2, 2014
Revised: May 20, 2014
Accepted: June 10, 2014
Published online: August 16, 2014
Abstract

A 50-year-old male who underwent a HeartMate II left ventricular assist device placement for ischemic cardiomyopathy presented with discolored urine and hemolysis 3 mo after the operation. His hemolysis was thought to be due to thrombosis within the pump. Imaging studies were not able to visualize a left ventricular thrombus. Medical management with anticoagulation failed and he underwent surgery for a pump exchange. Intraoperatively, a firm thrombus was found within the pump of the HeartMate II, and the color of the urine changed dramatically from cola-colored to yellow which enabled us to confirm the diagnosis.

Keywords: Cardiac surgery, Hemolysis, Left ventricular assist device, Thrombosis

Core tip: Diagnosis of pump thrombosis is difficult, but the intraoperative change of the color of urine may be seen almost immediately after pump exchange. This report also highlights the technical aspect of replacing the HeartMate II pump, and we believe the images are educational for the readers.