A patient with dilated cardiomyopathy and no history of thromboembolic events received a surgically implanted axial-flow left ventricular assist device. After implantation, transesophageal echocardiography revealed a giant thrombus on the lateral and anterior aspects of the left ventricle. The inflow cannula inserted through the apex of the left ventricle was not obstructed, and the device generated satisfactory blood flow. Laboratory screening for thrombophilia showed protein S deficiency, heterozygous factor V Leiden mutation, and heterozygous MTHFR C667T mutation. During the entire duration of circulatory support, no significant suction events were detected, and the patient was listed for heart transplantation. Ventricular assist device implantation can unmask previously undiagnosed thrombophilia; therefore, it should be necessary to identify thrombophilic patients before cardiac support implantation.

• Keywords
• Anticoagulants/therapeutic use, blood coagulation disorders/complications, factor V Leiden, factor V/genetics, left ventricular assist device, perioperative care, postoperative complications, thrombophilia/genetics, thrombus/etiology/prevention & control,
• MeSH
• Echocardiography, Doppler, Color MeSH
• Cardiomyopathy, Dilated complications   physiopathology   MeSH
• Echocardiography, Transesophageal MeSH
• Factor V genetics   MeSH
• Fatal Outcome MeSH
• Ventricular Function, Left * MeSH
• Genetic Predisposition to Disease MeSH
• Genetic Testing methods   MeSH
• Prosthesis-Related Infections etiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Methylenetetrahydrofolate Reductase (NADPH2) genetics   MeSH
• Mutation MeSH
• DNA Mutational Analysis MeSH
• Protein S Deficiency complications   diagnosis   genetics   MeSH
• Heart Diseases blood   diagnostic imaging   etiology   genetics   MeSH
• Heart-Assist Devices adverse effects   MeSH
• Predictive Value of Tests MeSH
• Prosthesis Design MeSH
• Echocardiography, Doppler, Pulsed MeSH
• Heart Failure diagnostic imaging   etiology   physiopathology   therapy   MeSH
• Stroke Volume MeSH
• Thrombophilia blood   complications   diagnosis   genetics   MeSH
• Thrombosis blood   diagnostic imaging   etiology   genetics   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Names of Substances
• factor V Leiden MeSH Browser
• Factor V MeSH
• Methylenetetrahydrofolate Reductase (NADPH2) MeSH
• MTHFR protein, human MeSH Browser