SESSION TITLE: Procedures Case Report Posters
SESSION TYPE: Affiliate Case Report Poster
PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM
INTRODUCTION: The total artificial heart (TAH) is a mechanical device which is used as a bridge to heart transplant in patients with biventricular failure. Patients receiving TAH support are required to be on anticoagulation therapy. We report the airway complications of TAH and the use of a gastrointestinal endoscopic retrieval basket to remove a blood clot from the airway.
CASE PRESENTATION: A 52 year old African American male with a past medical history of non-ischemic cardiomyopathy (EF 15%) from viral infection was admitted with decompensated heart failure. The patient required mechanical ventilation and subsequently veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for hypoxic respiratory failure and biventricular failure and subsequent TAH implantation. On hospital day 19, the patient developed increased peak airway pressures and loss of TAH flows with hypotension. Emergent bronchoscopy was performed which demonstrated a massive blood clot straddling the carina and obscuring both proximal main stems with a “ball-valve effect” during ventilation. The interventional pulmonary (IP) service was consulted for assistance and the clot was removed with a gastrointestinal polyp basket (Roth Net, US Endoscopy). It measured approximately 14cm in length and 4cm in width. Airway pressures, volumes and TAH function returned to normal immediately and no pneumothorax was found.
DISCUSSION: The TAH has been approved by FDA as a bridge to transplant in patients awaiting cardiac transplantations. Airway bleeding with subsequent air trapping via a ball-valve phenomenon is an emergent complication which can be of dire consequences if not recognized early and treated.
CONCLUSIONS: Airway bleeding and clot formation in the airway can lead to lung collapse, respiratory failure, hypotension and loss of TAH flows. Early recognition is the key to survival. Endoscopic retrieval basket can easily remove the clot and restore homeostasis.
Reference #1: Shah KB, Smallfield MC, Tang DG et al.Mechanical circulatory support devices in the ICU. Chest. 2014 Sep;146(3):848-57. doi: 10.1378/chest.13-2645.
DISCLOSURE: The following authors have nothing to disclose: Vikas Pathak, Colin Donovan, Rajiv Malhotra
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