Browsing by Author "Saleem, Kashif"

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    Aortic root thrombosis leading to STEMI in a Heartmate 3 patient
    (Springer, 2023-03) Ilonze, Onyedika J.; Torabi, Asad; Guglin, Maya; Saleem, Kashif; Rao, Roopa; Medicine, School of Medicine
    Despite left ventricular assist device (LVAD) therapy becoming established for end-stage heart failure (HF), complications remain. Thromboembolic complications are rare with the newest iteration of LVADs. We managed a case of a continuous-flow LVAD-related thromboembolic event that presented as an acute myocardial infarction. A 64-year-old male who underwent Heartmate III® LVAD implantation had crushing substernal chest pain and ventricular tachycardia with acute anterolateral myocardial infarction on electrocardiogram on post-operative day 9. Echocardiography showed closed aortic valve and mild aortic regurgitation, but CT angiography showed thrombus within the left coronary cusp despite full anticoagulation. Continuous suction of blood from the left ventricle despite pulsatile flow into the ascending aorta resulted in a minimally opening aortic valve and stagnation of blood leading to thrombosis on the coronary cusp. Apart from post-operative ventricular tachycardia and right ventricular failure, he had adequate body size (body surface area 2.13 m2) and no post-operative or coagulopathy which could predispose him to thrombosis. Coronary angiography revealed stable severe three-vessel disease and thrombus in left main and proximal circumflex artery, and he had aspiration thrombectomy, and international normalized ratio target was increased to 3–3.5 with aspirin 325 mg daily. He survived to discharge but died 60 days after LVAD implant with multiple low flow alarms, and cardiac arrest. We review the literature and propose a management algorithm for patients with impaired AV opening and aortic root thrombosis.
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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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    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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    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.
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    A Young Woman With Viral Myocarditis
    (JAMA Network, 2022-02) Rao, Roopa; Torabi, Asad J.; Saleem, Kashif; Medicine, School of Medicine