The use of a Berlin Heart EXCOR LVAD in a child receiving chemotherapy for Castleman's disease

We present the unique case of a pediatric patient who received chemotherapy for a diagnosis of CD, while mechanically supported with a Berlin EXCOR LVAD secondary to restrictive cardiomyopathy. A four‐yr‐old previously healthy male with restrictive cardiomyopathy required MCS after cardiac arrest bu...

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Bibliographic Details
Published in:Pediatric transplantation 2015-02, Vol.19 (1), p.E15-E18
Main Authors: Thomas, Tamara O., Chandrakasan, Shanmuganathan, O'Brien, Maureen, Jefferies, John L., Ryan, Thomas D., Wilmot, Ivan, Baker, Michael L., Madueme, Peace C., Morales, David, Lorts, Angela
Format: Article
Language:English
Subjects:
cardiac function
cardiomyopathy
Cardiomyopathy, Restrictive - complications
Cardiomyopathy, Restrictive - surgery
Castleman Disease - complications
Castleman Disease - drug therapy
Castleman's disease
Child, Preschool
Heart-Assist Devices
Humans
lymphoproliferative disorder
Male
mechanical circulatory
pediatric heart transplant
support
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Summary:We present the unique case of a pediatric patient who received chemotherapy for a diagnosis of CD, while mechanically supported with a Berlin EXCOR LVAD secondary to restrictive cardiomyopathy. A four‐yr‐old previously healthy male with restrictive cardiomyopathy required MCS after cardiac arrest but was diagnosed with multicentric CD, a non‐malignant lymphoproliferative disorder fueled by excessive IL‐6 production. Treatment with IL‐6 blockade (tocilizumab) every two wk and methylprednisolone had no effect on his lymph nodes or cardiac function while on temporary RotaFlow. A Berlin LVAD was placed for treatment with rituximab, COP, vincristine, and methylprednisolone. After three courses of chemotherapy, his inflammatory markers normalized and his lymphadenopathy decreased but cardiac function remained severely depressed. He tolerated chemotherapy on the Berlin but required frequent titrations of his anti‐coagulation regimen and he did suffer a hemorrhagic stroke. His clinical status improved significantly with rehabilitation, and he tolerated heart transplantation without further complications. MCS is a feasible option as a bridge to recovery or heart transplant eligibility for patients with hemodynamic collapse requiring chemotherapy but it does necessitate close titration of the anti‐coagulation regimen to coincide with changes in the inflammatory state.
ISSN:1397-3142
1399-3046
DOI:10.1111/petr.12398