Patient 1
On March 2020 a 61 years old patient was admitted to our Department
because of acute right heart failure, 2-month after LVAD implantation
for primary dilated cardiomyopathy. He was also affected by obesity with
body mass index of 36 kg/mq, type 2 diabetes, Chronic obstructive
pulmonary disease (COPD), chronic kidney disease (CKD), atrial flutter,
moderate to severe mitral regurgitation. A Cardiac Resynchronization
Therapy Defibrillator (CRT-D) had been implanted six years before.
Clinical examination at admission revealed peripheral edema, severe
dyspnea and increased weight
(>10 kg compared to previous discharge). He was apyretic,
hemodynamically stable with an oxygen saturation of 98%. Patient’s
chest X-ray is shown figure 1, with evidence of left pleural effusion.
Transthoracic echocardiogram concluded for right ventricular dysfunction
and pulmonary hypertension. The LVAD was functioning well. Infusion of
dobutamine, levosimendan and furosemide was immediately started.
The day after the admission, a nasopharyngeal swab was positive for
SARS-CoV-2. Thus he was transferred to a dedicated COVID-19 ward.
During the following days his hemodynamic condition gradually improved,
with a weight loss of 10 kg. Dobutamine was progressively reduced and
discontinued. We report a unique episode of fever during the second day
after admission, which was treated with paracetamol. The patient did not
develop pneumoniae and, after 8 days, since clinical conditions, blood
and radiological tests improved, he was discharged.
At clinical follow up two and half months later he was hemodynamically
stable, without signs of right heart failure. At follow-up the swab test
for SARS-CoV-2 was negative.