Mohammed A. Quader

Hospital readmissions after discharge to home with the Total Artificial Heart Freedom driver: Readmission reasons, clinical outcomes, and health care costs.

Hospital readmissions after discharge to home with the Total Artificial Heart Freedom driver: Readmission reasons, clinical outcomes, and health care costs Mohammed A. Quader, MD, Andrew J. Green, BS, Keyur B. Shah, MD, Richard Cooke, MD, and Vigneshwar Kasirajan, MD From the Department of Surgery, Division of Cardio-thoracic Surgery; and the Department of Medicine, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia

Left Ventricular Assist Device and Heart Transplantation in Hemophilia A Patient

We report here a hemophilia patient who was bridged with a left ventricle assist device and later received heart transplantation. Preparation for surgery with factor VIII supplementation, intraoperative conduct of surgery, and challenges of postoperative course are described with a brief literature review.

Dobutamine induced eosinophilic myocarditis and right heart failure requiring emergent biventricular assist device implantation.

Dobutamine is a rare and unrecognized cause of eosinophilic myocarditis (EM). It is even more unique for it to cause significant clinical deterioration. Patients with end stage cardiomyopathy have very little cardiac reserve and dobutamine induced myocarditis may cause enough harm to require urgent mechanical circulatory support. We describe a man with dilated cardiomyopathy that developed accelerated clinical deterioration from dobutamine induced EM. He had a predominance of right heart failure, requiring an urgent biventricular assist device and acutely responded to withdrawal of dobutamine.

Internal Versus External Compression of a Left Ventricular Assist Device Outflow Graft: Diagnosis With Intravascular Ultrasound and Treatment With Stenting

Obstruction within the circuit of a left ventricular assist device (LVAD) is a challenging situation for clinicians to definitively diagnose and manage. Available diagnostic tools are limited in their ability to visualize large portions within the device and cannulas, often leading to uncertainty as to whether redo surgery is required or if there are feasible medical or percutaneous alternatives. Here, we report a case of LVAD outflow graft obstruction, which by computed tomographic angiography (CTA) appeared to be intramural thrombus, but by intravascular ultrasound (IVUS) was shown to be compression external to the graft. A 62-year-old female with a continuous flow LVAD (HeartMate II Abbott, IL) 5 years prior presented to the emergency department with frequent low-flow alarms and syncope. The patient’s post-LVAD course had been complicated by outflow graft infection 1 year after initial implantation, necessitating an outflow graft replacement. She had also experienced multiple bleeding events for which her warfarin therapeutic goal was lowered. In the preceding year, her LVAD flows had steadily declined from 4.5 to 5.0 L/min to 2.7 to 2.8 L/min with an increasing frequency of low-flow alarms not responsive to the intravenous fluid administration or changes in LVAD …

Left Ventricular Volume Reduction Surgery for Idiopathic Dilated Cardiomyopathy

In the United States alone, 4.8 million people suffer from congestive heart failure (CHF). Approximately 550,000 new cases of CHF are diagnosed each year (1). As the population ages, the magnitude of this problem is projected to increase (2). After diagnosis, despite improvements in medical management, 5-year mortality is 60% for men and 45% for women (1). There are 150,000 people in the end stage of this disease, and there is a 5-year mortality that approaches 100% despite the use of angiotensin II-converting enzyme inhibitors (3). Approximately half of these patients have heart failure from idiopathic, infectious, or valvular etiologies unrelated to coronary artery disease (4).