HFSA ePoster Library

56-year-old Caucasian male with Heartmate 3 Left Ventricular Assist Device (LVAD) presented with intense sudden onset of “muscle tearing chest pain”. Chest CT scan with contrast showed acute dissection of left main pulmonary artery (Figure 1). On examination patient was mostly symptom free with minimal pain. He was hemodynamically stable with heart rate of 76 bpm, mean arterial pressure of 76mmHg and oxygenating 96% on room air and stable LVAD parameters (flow 4.3L/min, rpms 5600, PA 3.9, power 4.5).
Past Medical History- Patient had presented 2 years prior in cardiogenic shock. He was initially supported on Impella 5.0 and then underwent LVAD placement due to further deterioration. Peri operative course was complicated by acute right heart failure requiring Protec Duo placement. Unfortunately, patient also suffered acute embolic stroke around the same time and was left with residual left hemiparesis. Patient was supported on Protec Duo for nearly 3 weeks prior to recovery of right heart function and underwent successful decannulation without any complications.
Management-Patient was evaluated by surgical team and was deemed not a good surgical candidate due to underlying co-morbidities. He was evaluated by Interventional radiology and elected to manage conservatively as patient was hemodynamically stable with resolved symptoms. Repeat chest CT scan 3 days later showed stable dissection. Patient was discharged home in stable condition.
Discussion This is the first case reported in the literature of pulmonary artery dissection (PAD) in a patient with LVAD. PAD is very rare with less than 200 reported cases in the literature with no clear direction as to the management of the condition. It is usually seen in patients with known pulmonary artery disease like pulmonary hypertension and in congenital heart disease patients with dilated pulmonary artery. It is also reported as a procedural complication of pulmonary valve intervention. Although we cannot say conclusively, we hypothesize that placement of Protec Duo might have caused damage to the pulmonary artery previously. With increasing use of percutaneous circulatory support, one must be cautious of this potential complication. Figure 1 :Dissection flap of the left pulmonary artery originates immediately distal to the main pulmonary artery bifurcation, extending through the length of the left pulmonary artery to the level of the left lower interlobar pulmonary artery, no definite segmental extension is identified. The maximal diameter of the dissection flap is 1.1 cm: at this level the true lumen of the main pulmonary artery measures 5 mm. No significant associated thrombus is seen.