CASE PRESENTATION
A 63-year-old male was admitted to our institution in May 2020 with
shortness of breath and a history of ischemic cardiomyopathy resulting
in New York Heart Association Class IV heart failure. In the process of
multi-disciplinary workup for consideration for heart transplant, he was
found to be COVID-19 positive by PCR assay. The test was repeated and
confirmed positive.
He was relocated to the COVID-19 intensive care unit and isolated.
Chest radiograph demonstrated a dense left lower lobe pneumonia which
was treated with antibiotics. His heart failure was managed with dual
inotropes and tailored diuresis.
After two weeks of isolation, he underwent repeat COVID-19 testing which
was negative. His respiratory symptoms had improved, and his chest
radiography and CT scan showed resolution of the lower lobe infiltrate.
As a result, work-up was re-instituted for heart transplant candidacy.
Right heart catheterization was obtained which revealed a pulmonary
wedge pressure of 33mmHg and a cardiac index of 1.44 L/min/m2 despite
dual inotropic therapy. The decision was made to place an intra-aortic
balloon pump. He was listed as UNOS Status 2 for heart
transplantation.
A suitable donor organ became available 72 hours following the patient
being listed for transplant. He was brought to the operating room and
underwent successful OHT. His post-operative course was unremarkable.
He was discharged on post-operative day 17.