LAUSR

A 65-year old male with past medical history of non-ischemic cardiomyopathy, heart failure with reduced ejection fraction of 5e10% and chronic atrial fibrillation on anticoagulation, was admitted to our hospital due to repeated episodes of flash pulmonary edema. After the patient was medically stabilized, a left ventricular assist device (LVAD) Thoratec HeartMate II was implanted as destination therapy. Anticoagulation was initiated the following day, but subsequently suspended for 24 hours due to lower gastrointestinal bleeding. Heparin-induced thrombocytopenia (HIT) was ruled by negative HIT antibody and serotonin reactive assay. An echocardiogram did not identify any complication in the immediate postoperative period. Per local protocol, gated cardiac computed tomography (CT) was performed, which showed a large thrombus (4.5 2.5 cm) in the aortic root (Panel A, arrowhead) involving the left and non-coronary sinuses, in close proximity to the left main coronary ostium (Panel B, arrow), and extending into the sinotubular junction and tubular aorta (Panel C). Pulmonary embolism was also detected in the distal right main pulmonary artery and proximal right upper lobar artery (Panel D, asterisk). Due to high operative risk, the patient was managed medically and discharged in hemodynamically stable conditions. The patient has been followed as an outpatient for more than a year without any clinical events.