Advanced Heart Failure Secondary to Chagas Cardiomyopathy: A Case of Successful Left Ventricular Assist Device Placement

TL;DR

A patient with advanced heart failure from Chagas disease successfully received a left ventricular assist device when a heart transplant was not possible.

Contribution

This case highlights LVAD as a viable treatment for Chagas cardiomyopathy in patients ineligible for transplantation.

Findings

LVAD implantation improved clinical stability and symptoms in a patient with severe Chagas cardiomyopathy.

Multidisciplinary care was essential for managing both cardiac and infectious disease aspects.

The patient showed adherence to medical therapy one month post-LVAD implantation.

Abstract

Chagas cardiomyopathy is a rare but critical cause of nonischemic heart failure, particularly in patients from endemic regions. We present a 48-year-old Spanish-speaking male from Guatemala with hypertension, hyperlipidemia, and heart failure with reduced left ventricular ejection fraction (LVEF, 10%) due to Chagas disease. Despite guideline-directed medical therapy and implantable cardioverter-defibrillator (ICD) placement, he developed cardiogenic shock. Right heart catheterization confirmed severely reduced cardiac output and elevated wedge pressure. He was ineligible for heart transplantation due to limited life expectancy but had no contraindications to left ventricular assist device (LVAD) placement. Following infectious disease clearance and prophylaxis for Trypanosoma cruzi, he successfully underwent LVAD implantation. At one-month follow-up, he showed clinical stability, improved symptoms, and adherence to medical therapy. Our case discusses the role of LVAD as a life-extending option in Chagas cardiomyopathy for non-transplant candidates, emphasizing the importance of multidisciplinary care in managing both cardiac and infectious components.

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