====== Ventricular assist device ======

A ventricular assist [[device]] (VAD) is an electromechanical device for assisting cardiac circulation, which is used either to partially or to completely replace the function of a failing [[heart]]. The function of VADs is different from that of artificial cardiac pacemakers; some are for short-term use, typically for patients recovering from [[myocardial infarction]] (heart attack) and for patients recovering from cardiac surgery; some are for long-term use (months to years to perpetuity), typically for patients suffering from advanced heart failure.
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[[Septicemia]] is the leading cause of [[mortality]] in left [[ventricular assist device]]. Bloodstream [[infection]] is a [[risk factor]] for [[intracranial hemorrhage]]. 

Lee et al. reported three left ventricular assist device recipients who presented with bloodstream infection and developed [[aneurysmal subarachnoid hemorrhage]]. Case 1, a 37-year-old male with non-ischemic cardiomyopathy with HeartMate II, presented with confusion and found to have serratia bloodstream infection and left frontal lobe subarachnoid hemorrhage. The cerebral angiogram showed a right M3/M4 branch infectious intracranial aneurysm. He was treated with coil embolization and underwent device exchange. Case 2, a 41-year-old male with non-ischemic cardiomyopathy with HeartMate II presented with confusion and found to have methicillin-resistant Staphylococcus aureus bloodstream infection and bilateral frontal convexity subarachnoid hemorrhage. A cerebral angiogram showed left M3 and left A3 infectious intracranial aneurysms, which were treated with antibiotics alone. Case 3, a 58-year-old female with ischemic cardiomyopathy with HeartMate II presented with fever, found to have candida Albicans bloodstream infection and a parieto-occipital enhancing lesion concerning for cerebral abscess. Repeat computed tomography brain a week later showed a new right frontal subarachnoid hemorrhage. The cerebral angiogram showed a M4/M5 junction infectious intracranial aneurysm; the patient was not a surgical candidate and was transitioned to hospice. This case series emphasizes that left ventricular assist device-associated subarachnoid hemorrhage may be caused by infectious intracranial aneurysms when acute bloodstream infections are present
((Lee T, Buletko AB, Matthew J, Cho SM. Bloodstream infection is associated with
subarachnoid hemorrhage and infectious intracranial aneurysm in left ventricular 
assist device. Perfusion. 2019 Jul 24:267659119858853. doi:
10.1177/0267659119858853. [Epub ahead of print] PubMed PMID: 31339450.
)).