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CARDIOVASCULAR ANESTHESIOLOGY

Left Ventricular Assist Device Outflow Cannula Obstruction by the Rare Environmental Fungus Myceliophthora thermophila

Nathaen Weitzel, MD^*, Ferenc Puskas, MD^*, Joseph Cleveland, MD, Marilyn E. Levi, MD, and Tamas Seres, MD^*

From the Departments of *Anesthesia, Surgery, and Medicine, University of Colorado Denver and Health Sciences Center, Aurora, Colorado.

Address correspondence to Nathaen Weitzel, MD, Leprino Office Building, Department of Anesthesiology, 12401 E. 17th Ave., B113 Aurora, CO 80045. Address e-mail to nathaen.weitzel{at}uchsc.edu.

Abstract

Left ventricular assist devices are used to provide mechanical circulatory support during end-stage heart failure either as a destination therapy or as a bridge to heart transplantation. Perioperative transesophageal echocardiography is becoming an invaluable tool to investigate device function during implantation and in case of mechanical malfunction. Most malfunctions are due to inflow graft occlusion, or device malfunction, while outflow graft dysfunction is rare. Here, we present a case of severe outflow conduit obstruction by a rare environmental fungus, Myceliophthora thermophila. After replacement of the infected device and intensive antifungal treatment, heart transplantation was performed 2 yr later.