Mirasol RV, Tholany JJ, Reddy H, Fyfe-Kirschner BS, Cheng CL, Moubarak IF, Nosher JL. Gastrointestinal bleeding in a patient with a continuous-flow biventricular assist device. World J Radiol 2016; 8(4): 428-433 [PMID: 27158430 DOI: 10.4329/wjr.v8.i4.428]
Corresponding Author of This Article
John L Nosher, MD, Department of Radiology, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, Medical Education Building, Room #404, New Brunswick, NJ 08901, United States. nosher@rutgers.edu
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Case Report
Open-Access Policy of This Article
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/
World J Radiol. Apr 28, 2016; 8(4): 428-433 Published online Apr 28, 2016. doi: 10.4329/wjr.v8.i4.428
Gastrointestinal bleeding in a patient with a continuous-flow biventricular assist device
Raymond V Mirasol, Jason J Tholany, Hasini Reddy, Billie S Fyfe-Kirschner, Christina L Cheng, Issam F Moubarak, John L Nosher
Raymond V Mirasol, Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, United Sates
Jason J Tholany, Issam F Moubarak, John L Nosher, Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United Sates
Hasini Reddy, Billie S Fyfe-Kirschner, Department of Pathology, Robert Wood Johnson University Hospital, New Brunswick, NJ 08901, United Sates
Christina L Cheng, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ 08901, United Sates
Author contributions: Mirasol RV, Tholany JJ and Nosher JL designed the report; Reddy H, Fyfe-Kirschner BS, Cheng CL and Moubarak IF collected the patient’s clinical data and made critical revisions to the manuscript; Mirasol RV, Reddy H, Moubarak IF and Nosher JL wrote the paper; all authors gave final approval for the article to be published.
Institutional review board statement: Rutgers Health Sciences New Brunswick Institutional Review Board, New Brunswick, New Jersey. This Institutional Review Board does not require review of a single case study.
Informed consent statement: All study participants provided verbal consent to participation in this study.
Conflict-of-interest statement: The authors of this study report no conflict-of-interest in the performance or publication of this study.
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: John L Nosher, MD, Department of Radiology, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, Medical Education Building, Room #404, New Brunswick, NJ 08901, United States. nosher@rutgers.edu
Telephone: +1-732-2357721 Fax: +1-732-2356889
Received: November 9, 2015 Peer-review started: November 9, 2015 First decision: December 7, 2015 Revised: January 21, 2016 Accepted: February 14, 2016 Article in press: February 16, 2016 Published online: April 28, 2016 Processing time: 162 Days and 9.4 Hours
Abstract
The association between continuous-flow left ventricular assist devices (CF-LVADs) and gastrointestinal (GI) bleeding from angiodysplasia is well recognized. However, the association between continuous-flow biventricular assist devices (CF-BIVADs) and bleeding angiodysplasia is less understood. We report a case of GI bleeding from a patient with a CF-BIVAD. The location of GI bleeding was identified by nuclear red blood cell bleeding scan. The vascular malformation leading to the bleed was identified and localized on angiography and then by pathology. The intensity of bleeding, reflected by number of units of packed red blood cells needed for normalization of hemoglobin, as well as the time to onset of bleeding after transplantation, are similar to that seen in the literature for CF-LVADs and pulsatile BIVADs. While angiography only detected a dilated late draining vein, pathology demonstrated the presence of both arterial and venous dilation in the submucosa, vascular abnormalities characteristic of a late arteriovenous malformation.
Core tip: Gastrointestinal (GI) bleeding from angiodysplasia is a recognized complication in patients with continuous-flow left ventricular assist devices. The pathogenesis of the association, including coagulopathy and mechanics related to blood flow through the device, remains under investigation. We review a case of GI bleeding in a patient with a continuous-flow biventricular assist device.
