Right ventricular failure due to late embolic RV infarction during continuous flow LVAD support.

This report describes a 63-year-old man with a dilated cardiomyopathy, who was supported with a continuous flow left ventricular assist device (LVAD), and on the waiting list for heart transplantation. After a long period of stability, he presented with recurrent ventricular tachycardia and rapidly developed progressive right ventricular (RV) failure. He required implantation of a temporary RV assist device to regain stability and subsequently underwent urgent heart transplantation. The explanted heart showed multiple areas of ischaemic damage to the RV myocardium, but there was no significant underlying coronary artery disease. It appears that the ventricular arrhythmias and subsequent RV failure were due to an embolic event in the territory of the right coronary artery. The case highlights that coronary embolism is a rare cause of RV failure during LVAD support and demonstrates the utility of temporary RV assist device support as a bridge to heart transplantation.