Abstract
The ventricular assist device (VAD) has been successfully used in the treatment of end-stage heart failure, particularly as a bridge to heart transplantation, in Japan. We report a case of intracerebral hemorrhage (ICH) in a patient supported by VAD. The patient was a 41-year-old woman diagnosed with dilated cardiomyopathy. Medical treatment was provided but her heart failure worsened; she therefore underwent bi-VAD implantation as a bridge to heart transplantation. Three months after implantation, the patient experienced consciousness disturbance and right hemiparesis. Computed tomography revealed a massive ICH in the left frontal lobe. According to our protocol for the management of ICH, we immediately administered recombinant coagulation factor IX (nonacog alfa) 1,000 IU, vitamin K 10 mg, and fresh-frozen plasma 5U. However, the patient reported right hemiparesis and disturbance in consciousness; hematoma removal and decompressive craniectomy were therefore performed. The patient recovered without any neurological deficits and is now waiting for a heart transplant. The number of patients supported by VAD is increasing in Japan; therefore, neurosurgeons should have accurate knowledge of the various problems associated with VAD.
