Successful management of mycotic visceral aneurysms in a LVAD patient and navigating LVAD postoperative challenges

Abstract

This report presents a unique case of concurrent mycotic aneurysms in a 64-year-old male left ventricular assist device (LVAD) recipient. Initially admitted with odontogenic maxillary fungal sinusitis and fungemia, he later presented to our clinic with significant weight loss, fatigue, and LVAD complications. Imaging revealed a large complex mid-superior mesenteric artery aneurysm with multiple associated jejunal branches and a ruptured splenic aneurysm. Although these aneurysms were successfully managed, it is important to note the challenges in postoperative care, including anticoagulation-related complications such as post-splenectomy hematoma and intracranial bleeding. This case highlights the delicate balance between therapeutic interventions and managing LVAD-related complexities.

Keywords: LVAD; Left ventricular assist device; Mycotic aneurysms; SMA aneurysms; Visceral aneurysms.

Fig

Intraoperative visualization of the aneurysm before and after removal. Aneurysmal sac was identified with dissection completed, and the branches off the superior mesenteric artery (SMA) were identified and slinged (A). The SMA reconstruction with a left femoral vein graft was completed (B).