The patient was implanted with a left ventricular assist device (lvad) on (b)(6) 2016.It was reported that the patient was admitted to the hospital overnight for increased low flow alarms when lying on the right side.The patient presented with symptoms of shortness of breath.The patient had been seen in clinic the prior day and was found to be euvolemic and was discharged home.The patient¿s lactate dehydrogenase (ldh) and inr were within normal limits.Technical services reviewed the submitted log file and low flow alarms were confirmed.Ct angiographic examination was performed including 3d reconstruction.The findings showed that there were significant stenosis of the lvad outflow graft, occurring between the outflow graft and the outflow graft bend relief.The stenosis was caused by intraluminal thrombus.Other findings were cardiomegaly, mild pulmonary edema, and mild lung peripheral fibrotic changes.The patient went to the cardiac catheterization lab on (b)(6) 2018 with attempted stenting at the lvad outflow graft.Initial stent was deployed; however, further kinking of the outflow graft occurred.Another attempt resulted in successful percutaneous stenting of the lvad outflow graft.Low flow alarms continued post-procedure, and were initially thought to be secondary to acute blood loss anemia from a right groin hematoma.The patient had lost significant blood due to groin hematomas from the procedure.Ct scan revealed a new alteration of the contour of the outflow graft, with unchanged severe stenosis.The outflow graft kink had migrated further down with residual stenosis.The patient¿s heart failure worsened.The patient received 2 units of packed red blood cells (prbc) and went to the catheterization lab again that night for additional intervention to mitigate the outflow graft stenosis.Ct angiography of the chest on (b)(6) 2018 showed interval stenting with stenosis of 50%.The stenting procedure that night was successful and the patient returned to the intensive care unit (icu) for continued management.The patient continued to do well and was stable for discharge home.No additional information was provided.
|