Missing the blind spot in a HeartMate 3 outflow graft obstruction caused by fungal infection

A patient was admitted in cardiogenic shock and a constant decrease of pump flow requiring combined inotropic support. To evaluate the cause, echocardiography and a ramp test were performed. The results suggested a LVAD related problem - particularly a suspected outflow graft obstruction. Wether CT scan nor angiography confirmed the assumption. However, a post-mortem LVAD examination revealed an outflow obstruction caused by a fungal thrombus formation invisible for standard imaging procedures.

Automated summary

A patient was admitted in cardiogenic shock with a suspected LVAD outflow obstruction, which was not confirmed by standard imaging but only revealed during a post-mortem examination. Despite the lack of confirmation from CT scan and angiography, a fungal thrombus formation was discovered as the cause of the outflow obstruction in the LVAD.