Acute Biventricular Heart Failure After COVID-19 Infection in an Orthotropic Heart Transplant Patient: A Case Report

Abstract

The cardiac effects of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) include myocarditis, takotsubo cardiomyopathy, pericardial effusion and cardioembolic events in the general population. Effects of SARS-CoV-2 in heart transplant patients is unclear. We describe a case of myocarditis in the transplanted heart that responded to methylprednisolone.

SARS-CoV-2 infection in heart transplant recipients: a systematic literature review of clinical outcomes and immunosuppression strategies

“…Of the thirty-three studies, eleven were retrospective case series [ 7 , 11 , 14 , 19 , 20 , 26 , 29 – 33 , 38 , 39 ], while twenty-two were case reports [ 8 – 10 , 12 , 13 , 15 – 18 , 21 – 25 , 27 , 28 , 34 – 37 ]. All were peer-reviewed.…”

“…In five of the studies, 2-D echocardiography revealed decreased LV ejection fraction (EF) [ 11 , 14 , 24 , 28 , 32 ]. Of the five studies, one did not undergo repeat endomyocardial biopsies due to a recent negative biopsy and the other who had severe biventricular dysfunction that required retransplantation had an endomyocardial biopsy that ruled out acute humoral rejection and no mention was made of viral particles within the myocardium or inflammation [ 21 ].…”

“…Of the five studies, one did not undergo repeat endomyocardial biopsies due to a recent negative biopsy and the other who had severe biventricular dysfunction that required retransplantation had an endomyocardial biopsy that ruled out acute humoral rejection and no mention was made of viral particles within the myocardium or inflammation [ 21 ]. The last case [ 28 ] had no evidence of acute cellular rejection (grade 0R) or antibody-mediated rejection and ejection fraction and recovered after 4 days spontaneously.…”

“… Does the case report provide take away lessons? Total score Ahluwalia et al [ 11 ] ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ 100% Ammirati et al [ 12 ] ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ 100% Berg et al [ 28 ] ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ 100% Ballout et al [ 29 ] ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ 100% Bosch et al [ 13 ] ✓ ✓ X X X X ✓ ✓ 50% Carraffa et al [ 14 ] ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ 100% ...…”

Xuefu Zhuyu Decoction on Heart Failure Patients with Middle-Range Coronary Heart Disease with Ejection Fraction

“…With further clinical study regarding the Heart Failure (HF) pathophysiological mechanism, middlerange HF with ejection fraction, as a "grey area" of HF has gradually attracted great attention from the cardiovascular academic community [1,2] . The European Society of Cardiology (ESC) first defined it in 2016 as a special type of HF with clinical features between those with preserved ejection fraction (Left Ventricular Ejection Fraction (LEEF)<40 %) and decreased ejection fraction (LEEF<40%).…”