Browsing by Author "Rao, Roopa A."

Now showing 1 - 8 of 8
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    A Case Report of Postheart Transplant Epicardial Adipose Deposition in a Patient With Dunnigan Syndrome
    (American College of Physicians, 2022) Bajpai, Vatsal; Damera, Nihanth; Pattisapu, Anish; Oral, Elif; Bateman, Pantila; Rao, Roopa A.; Medicine, School of Medicine
    Dunnigan syndrome is a rare genetic disorder that is a type of familial partial lipodystrophy. In some patients, severe cardiomyopathy and heart transplantation have been reported in this syndrome. Here, we describe a 40-year-old patient with Dunnigan syndrome who underwent heart transplantation for end-stage heart failure. Post-transplantation, routine imaging showed an accumulation of epicardial adipose tissue around the heart. In general, in Dunnigan syndrome, epicardial fat accumulation is not different compared with that of the general population. This is the first case report of exaggerated accumulation of adipose tissue around the heart causing subtle pericardial tamponade physiology.
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    Fulminant myocarditis: COVID or not COVID? Reinfection or co-infection?
    (Future Medicine, 2021) Yeleti, Ramya; Guglin, Maya; Saleem, Kashif; Adigopula, Sasikanth V.; Sinha, Anjan; Upadhyay, Smrity; Everett, Jeffrey E.; Ballut, Kareem; Uppuluri, Sarada; Rao, Roopa A.; Medicine, School of Medicine
    We describe a unique case of fulminant myocarditis in a patient with presumed SARS-CoV-2 reinfection. Patient had initial infection 4 months backand had COVID-19 antibody at the time of presentation. Endomyocardial biopsy showed lymphocytic myocarditis, that is usually seen in viral myocarditis. The molecular diagnostic testing of the endomyocardial biopsy for cardiotropic viruses was positive for Parvovirus and negative for SARS-CoV-2. Authors highly suspect co-infection of SARS-CoV-2 and Parvovirus, that possibly triggered the immune cascade resulting in fulminant myocarditis. Patient was hemodynamically unstable with ventricular tachycardia and was supported on VA ECMO and Impella CP. There was impressive recovery of left ventricular function within 48 hours, leading to decannulation of VA ECMO in 72 h. This unique case was written by the survivor herself.
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    Heart Transplantation in Mustard Patients Bridged With Continuous Flow Systemic Ventricular Assist Device - A Case Report and Review of Literature
    (Frontiers, 2021-04) Bou Chaaya, Rody G.; Simon, Joel W.; Turrentine, Mark; Herrmann, Jeremy L.; Kay, William Aaron; Guglin, Maya; Saleem, Kashif; Rao, Roopa A.; Medicine, School of Medicine
    Thirty four-year-old male with history of D-transposition of the great arteries (D-TGA) who underwent Mustard operation at 14 months of age presented in cardiogenic shock secondary to severe systemic right ventricular failure. Catheterization revealed significantly increased pulmonary pressures. Due to the patient's inotrope dependence and prohibitive pulmonary hypertension, he underwent implantation of a Heart Ware HVAD® for systemic RV support. Within 4 months of continuous flow ventricular assist device (VAD) implantation complete normalization of pulmonary vascular resistance (PVR) was achieved. He ultimately underwent orthotopic heart transplantation with favorable outcomes. This is the second report of complete normalization of PVR following VAD implantation into a systemic RV in <4 months. We conducted a thorough literature review to identify Mustard patients that received systemic RV VAD as a bridge to a successful heart transplantation. In this article, we summarize the outcomes and focus on pulmonary hypertension reversibility following VAD implant.
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    Outcomes in patients with aortic stenosis and severely reduced ejection fraction following surgical aortic valve replacement and transcatheter aortic valve replacement
    (Springer Nature, 2024-04-20) Bain, Eric R.; George, Bistees; Jafri, Syed H.; Rao, Roopa A.; Sinha, Anjan K.; Guglin, Maya E.; Medicine, School of Medicine
    Background: Patients with severe aortic stenosis (AS) and left ventricular (LV) dysfunction demonstrate improvement in left ventricular injection fraction (LVEF) after aortic valve replacement (AVR). The timing and magnitude of recovery in patients with very low LVEF (≤ 25%) in surgical or transcatheter AVR is not well studied. Objective: Determine clinical outcomes following transcatheter aortic valve replacement (TAVR) and surgical aortic valve repair (SAVR) in the subset of patients with severely reduced EF ≤ 25%. Methods: Single-center, retrospective study with primary endpoint of LVEF 1-week following either procedure. Secondary outcomes included 30-day mortality and delayed postprocedural LVEF. T-test was used to compare variables and linear regression was used to adjust differences among baseline variables. Results: 83 patients were enrolled (TAVR = 56 and SAVR = 27). TAVR patients were older at the time of procedure (TAVR 77.29 ± 8.69 vs. SAVR 65.41 ± 10.05, p < 0.001). One week post procedure, all patients had improved LVEF after both procedures (p < 0.001). There was no significant difference in LVEF between either group (TAVR 33.5 ± 11.77 vs. SAVR 35.3 ± 13.57, p = 0.60). Average LVEF continued to rise and increased by 101% at final follow-up (41.26 ± 13.70). 30-day mortality rates in SAVR and TAVR were similar (7.4% vs. 7.1%, p = 0.91). Conclusion: Patients with severe AS and LVEF ≤ 25% have a significant recovery in post-procedural EF following AVR regardless of method. LVEF doubled at two years post-procedure. There was no significant difference in 30-day mortality or mean EF recovery between TAVR and SAVR.
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    Pulmonary artery dissection in a patient with right-sided mechanical circulatory support and an LVAD
    (Elsevier, 2022-12) Savsani, Parth; Chapa, Jeffrey; Saleem, Kashif; Ballut, Kareem; Ilonze, Onyedika; Guglin, Maya; Rao, Roopa A.; Medicine, School of Medicine
    The use of a left ventricular assist device (LVAD) is an essential treatment option for patients with advanced heart failure, as both a bridge to transplant and a destination therapy. It is important to consider the risks associated with an LVAD, however, as complications can present with a range of severity and chronicity. In the perioperative setting of LVAD implantation, right ventricular failure (RVF) can occur in an estimated 20% of patients. 1 ,2 RVF increases both morbidity and mortality, and it is reported that the 1-year survival rate is 60% in patients requiring biventricular support devices. 1 ,2 Temporary percutaneous right ventricular assist devices (RVAD) can be used until hemodynamic stability is achieved, or until the patient is bridged to a permanent RVAD or cardiac transplantation. In recent years, the TandemLife ProtekDuo (TandemLife, Pittsburg, PA) (TPD) or the CentriMag (Abbott, Chicago, IL) have been introduced as options for temporary right ventricular support. However, temporary RVADs also can cause a variety of complications, including, but not limited to, tricuspid regurgitation, hemolysis, cannula migration, or cerebrovascular insults. 1 ,3 When indicated, patients who require biventricular devices are at much higher risk of complications and adverse events, as compared to those with an LVAD or RVAD alone. Despite the documented risk, temporary RVADs remain one of very few options to treat RVF perioperatively and must be considered.
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    Special Considerations in the Care of Women With Advanced Heart Failure
    (Frontiers Media, 2022-07-11) Ebong, Imo A.; DeFilippis, Ersilia M.; Hamad, Eman A.; Hsich, Eileen M.; Randhawa, Varinder K.; Billia, Filio; Kassi, Mahwash; Bhardwaj, Anju; Byku, Mirnela; Munagala, Mrudala R.; Rao, Roopa A.; Hackmann, Amy E.; Gidea, Claudia G.; DeMarco, Teresa; Hall, Shelley A.; Medicine, School of Medicine
    Advanced heart failure (AHF) is associated with increased morbidity and mortality, and greater healthcare utilization. Recognition requires a thorough clinical assessment and appropriate risk stratification. There are persisting inequities in the allocation of AHF therapies. Women are less likely to be referred for evaluation of candidacy for heart transplantation or left ventricular assist device despite facing a higher risk of AHF-related mortality. Sex-specific risk factors influence progression to advanced disease and should be considered when evaluating women for advanced therapies. The purpose of this review is to discuss the role of sex hormones on the pathophysiology of AHF, describe the clinical presentation, diagnostic evaluation and definitive therapies of AHF in women with special attention to pregnancy, lactation, contraception and menopause. Future studies are needed to address areas of equipoise in the care of women with AHF.
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    A Unique Case of Systemic Lupus Erythematosus Myocarditis Complicated by Plasmapheresis-Responsive Cardiogenic Shock
    (Elsevier, 2020-12-09) Smith, Carson; Guglin, Maya; Dougherty, Rachel E.; Rao, Roopa A.; Medicine, School of Medicine
    A 25-year-old woman with systemic lupus erythematosus complicated by biventricular failure with a history of multiple admissions presented with cardiogenic shock unresponsive to steroids, intravenous immunoglobulin, cyclophosphamide, and required extra-corporeal membrane oxygenation. Left ventricular function eventually recovered after plasmapheresis.
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    Unusual Case of Pump Thrombosis in LVAD Patient with COVID-19 — Diagnostic Challenges
    (Gill Heart Institute, University of Kentucky, 2020-09-18) Frick, William H.; Mallory, Ryan D.; Guglin, Maya; Anderson, Eve; Lushin, Erin L.; Vivo, Rey P.; Saleem, Kashif; Rao, Roopa A.; Medicine, School of Medicine
    We present the first reported case of left ventricular assist device (LVAD) pump thrombosis in the setting of the coronavirus pandemic. We describe the clinical features of the case which helped to differentiate coronavirus disease 19 (COVID-19)from LVAD pump thrombosis. The patient is 56-year-old female supported by destination LVAD therapy. She was originally implanted with a HeartMate II device in 2015 and underwent two pump exchanges in 2017 and 2019 for pump thrombosis, despite medication adherence. Shortly after routine lab work revealed near doubling of her lactate dehydrogenase (LDH) levels, she tested positive for COVID-19. She then developed power spikes and symptomatic heart failure, which prompted hospital admission. An initial computed tomography (CT) scan showed bilateral ground glass opacities, but repeat testing was negative for COVID-19. Her LVAD pump thrombosis was treated with aspirin, unfractionated heparin, and cangrelor, which was guided by thromboelastogram. Over several weeks, her LDH returned to baseline, and she was transitioned from cangrelor to ticagrelor and from heparin to warfarin. A repeat CT scan after several days of IV diuresis showed resolution of the ground glass opacities.