Misplacement of LVAD inflow cannula leads to insufficient output and tissue hypoperfusion.

A 63-year-old man with a newly placed left ventricular assist device (LVAD) was emergently taken to the operating room for mediastinal exploration secondary to worsened LVAD output, hemodynamic instability, and organ hypoperfusion. Intraoperative transesophageal echocardiography showed the LVAD inflow cannula intermittently aspirating the atrial septal wall, resulting in occlusion of the inflow cannula. Upon gradual withdrawal of the inflow cannula by several centimeters, dramatic improvements in LVAD output, hemodynamics, and tissue perfusion occurred. Clinical implications of a patient who has a malfunctioning LVAD are discussed.