Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2015; 21(18): 5735-5738
Published online May 14, 2015. doi: 10.3748/wjg.v21.i18.5735
Left ventricular assist device hemolysis leading to dysphagia
Alexander Wuschek, Sara Iqbal, Jerry Estep, Eamonn Quigley, David Richards
Alexander Wuschek, Sara Iqbal, Jerry Estep, Eamonn Quigley, David Richards, Department of Medicine, Division of Gastroenterology, Houston Methodist Hospital, Houston, TX 77030, United States
Author contributions: Wuschek A, Iqbal S and Richards D contributed to the chart review, data collection, and writing of the manuscript; and Estep J and Quigley E provided expert review and editing of the manuscript.
Conflict-of-interest: Estep J reports honoraria received from Thoratec Corp. as a consultant and he is on the speaker bureau. None of the other authors have any conflicts-of-interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: David Richards, MD, Department of Medicine, Division of Gastroenterology, Houston Methodist Hospital, 6560 Fannin, Suite 1160, Houston, TX 77030, United States. drichards@houstonmethodist.org
Telephone: +1-713-9332650 Fax: +1-713-9332653
Received: November 17, 2014
Peer-review started: November 18, 2014
First decision: December 26, 2014
Revised: January 25, 2015
Accepted: February 11, 2015
Article in press: February 11, 2015
Published online: May 14, 2015
Abstract

A 41-year-old man with a continuous-flow left ventricular assist device presented for evaluation of dysphagia and dark urine. He was found to have a significantly elevated L-lactate dehydrogenase and an elevated plasma free hemoglobin consistent with intravascular hemolysis. After the hemolysis ceased, both the black urine and dysphagia resolved spontaneously. Transient esophageal dysfunction, as a manifestation of gastrointestinal dysmotility, is known to occur in the setting of hemolysis. Paroxysmal nocturnal hemoglobinuria is another recognized cause of massive hemolysis with gastrointestinal dysmotility occurring in 25%-35% of patients during a paroxysm. Intravascular hemolysis increases plasma free hemoglobin, which scavenges nitric oxide (NO), an important second messenger for smooth muscle cell relaxation. The decrease in NO can lead to esophageal spasm and resultant dysphagia. In our patient the resolution of hemolysis resulted in resolution of dysphagia.

Keywords: Hemolysis, dysphagia, Esophageal spasm, Nitric oxide, Left ventricular assist device

Core tip: Transient esophageal dysfunction, as a manifestation of gastrointestinal dysmotility, is known to occur in the setting of hemolysis. We present a case of dysphagia secondary to hemolysis caused by a continuous-flow left ventricular assist device. Our case report aims to bring this etiology of dysphagia to the attention of gastroenterologists and cardiologists to limit invasive investigations in these patients and highlight the possibility that hemolysis may serve as an early indicator of pump thrombosis and adverse outcomes.