Aortic Root Thrombosis With Multivessel Coronary Embolism Following Left Ventricular Assist Device Implantation

Background: Aortic root thrombosis is uncommon but potentially catastrophic in patients supported with continuous-flow left ventricular assist devices (LVADs). Case Summary: We describe a 28-year-old woman presenting with syncope 1 month after HeartMate 3 LVAD implantation. Electrocardiography demonstrated a myocardial infarction. Echocardiography revealed severe biventricular dysfunction, persistent aortic valve closure, and normal LVAD inflow velocities. The international normalized ratio was 1.4. Coronary angiography identified a mobile aortic root thrombus with multivessel coronary embolization. Given prohibitive embolic risk, intensive medical therapy was pursued, leading to clinical stabilization. Discussion: Early recognition and multidisciplinary management are critical when invasive strategies carry high risk. Take-Home Messages: Aortic root thrombosis is a rare but life-threatening complication in patients supported with continuous-flow LVADs. Acute ST-segment elevation myocardial infarction in patients with LVAD should prompt urgent evaluation for coronary embolism rather than atherosclerotic disease, especially in young patients without traditional risk factors. Management of aortic root thrombus with multivessel coronary embolization requires individualized, multidisciplinary decision-making.