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Publications (7 of 7) Show all publications
Sundbom, P., Hübbert, L. & Serrander, L. (2017). Progressive multifocal leukoencephalopathy after heart transplantation: 4 years of clinically stable infection on low-dose immunosuppressive therapy. Oxford Medical Case Reports, 2017(2), 15-17
Open this publication in new window or tab >>Progressive multifocal leukoencephalopathy after heart transplantation: 4 years of clinically stable infection on low-dose immunosuppressive therapy
2017 (English)In: Oxford Medical Case Reports, E-ISSN 2053-8855, Vol. 2017, no 2, p. 15-17Article in journal (Refereed) Published
Abstract [en]

Progressive multifocal leukoencephalopathy (PML), caused by reactivation of JC-virus is a relatively rare complication seen in patients with compromised immune system. There are no evidence-based treatment available and prognosis is poor. Withdrawal of immunosuppressant can result in further neurological deterioration and for patients with solid organ transplantations, fatal graft rejection. We report a 52-year-old women that presented with seizures within 1 month after heart transplantation. Initial diagnosis was vascular disease. After clinical deterioration 10 months after transplantation, further examinations led to the diagnosis. Minimizing tacrolimus, to a concentration of 2 ng/ml, and extensive physical therapy has improved the physical capacity of the patient. The patient has now been clinically stable for 4 years and extended survival for 5 years. This case adds to the limited adult cases of PML within the population of heart transplant recipients and the need for increased awareness to minimize diagnosis delay.

Place, publisher, year, edition, pages
Oxford Academic, 2017
National Category
Surgery Infectious Medicine
Identifiers
urn:nbn:se:liu:diva-145288 (URN)10.1093/omcr/omx003 (DOI)28473916 (PubMedID)
Available from: 2018-02-23 Created: 2018-02-23 Last updated: 2018-07-30Bibliographically approved
Sundbom, P., Ahn, H., Kornhall, B., Loebe, M. & Granfeldt, H. (2014). (556) – Change in Acoustic Fingerprints at Increased Pump Speed During Echocardiographic Ramp Test. In: : . Paper presented at 34th Annual Meeting and Scientific Sessions of the International-Society-for-Heart-and-Lung-Transplantation (pp. S206). Elsevier, 32(4S)
Open this publication in new window or tab >>(556) – Change in Acoustic Fingerprints at Increased Pump Speed During Echocardiographic Ramp Test
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2014 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Purpose

The continuous flow mechanical circulatory support HeartMate II (Thoratec Corporation, Inc. Pleasanton, USA) (HMII), generates an auditory signal (acoustic fingerprint) that can be registered by routine auscultation. A temporary or permanent change in sound indicates a change in pump function. Previous mock loop studies have shown that changes in acoustic fingerprint are due to changes in speed, so the aim of this study was to see if the acoustic fingerprint changed during an echocardiographic ramp test.

Methods

Four stable, event-free patients included in the SoundMate study performed an echocardiographic ramp test. The speed was increased stepwise by 400 rpm between 8 000 and 12 000 rpm, and the left ventricular end diastolic diameter, flow, power consumption and blood pressure were measured. Sounds from HMII were recorded using an iPhone™ (Apple Inc. Cupertino, CA, USA) with the stethoscope application iStethPro™ (Dr. Peter J Bentley, UK) and the frequency map analyzed using the Audacity™ program (Unicode, Ash, Chinen and Crook, USA). The acoustic fingerprint is divided into regions (R1: 1 000-6 500, R2: 8 500-14 000, R3: 15 000-21 000 Hz) and peaks (P1: 0-1 000, P2: 6 500-8 500, P4: 21 000-23 000 Hz) in order to facilitate calculations and clarify changes in frequency.

Results

There were significant (p<005) changes in the acoustic fingerprint when increasing the pump speed between 8 000 and 12 000 rpm. In 2/4 patients there were no significant changes in P1, otherwise there were significant changes in all regions and peaks. During the ramp test the power increased in mean 7 W, flow 3,1 L/min and the blood pressure measured with Doppler increased by ~15 mmHg. The left ventricular size decreased with ~2 cm.

Conclusion

The acoustic fingerprint changes with pump speed. This implies that when using sound check for detection of pump dysfunction, a new baseline should be set after every adjustment of speed.

Place, publisher, year, edition, pages
Elsevier, 2014
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-114003 (URN)10.1016/j.healun.2014.01.898 (DOI)000333866700557 ()
Conference
34th Annual Meeting and Scientific Sessions of the International-Society-for-Heart-and-Lung-Transplantation
Available from: 2015-02-05 Created: 2015-02-05 Last updated: 2017-06-29
Hubbert, L., Sundbom, P., Loebe, M., Peterzén, B., Granfeldt, H. & Ahn, H. (2014). Acoustic Analysis of a Mechanical Circulatory Support. Artificial Organs, 38(7), 593-598
Open this publication in new window or tab >>Acoustic Analysis of a Mechanical Circulatory Support
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2014 (English)In: Artificial Organs, ISSN 0160-564X, E-ISSN 1525-1594, Vol. 38, no 7, p. 593-598Article in journal (Refereed) Published
Abstract [en]

Mechanical circulatory support technology is continually improving. However, adverse complications do occur with devastating consequences, for example, pump thrombosis that may develop in several parts of the pump system. The aim of this study was to design an experimental clot/thrombosis model to register and analyze acoustic signals from the left ventricular assist device (LVAD) HeartMate II (HMII) (Thoratec Corporation, Inc., Pleasanton, CA, USA) and detect changes in sound signals correlating to clots in the inflow, outflow, and pump housing. Using modern telecom techniques, it was possible to register and analyze the HMII pump-specific acoustic fingerprint in an experimental model of LVAD support using a mock loop. Increase in pump speed significantly (P less than 0.005) changed the acoustic fingerprint at certain frequency (0-23 000 Hz) intervals (regions: R1-3 and peaks: P1,3-4). When the ball valves connected to the tubing were narrowed sequentially by similar to 50% of the inner diameter (to mimic clot in the out-and inflow tubing), the frequency spectrum changed significantly (P less than 0.005) in P1 and P2 and R1 when the outflow tubing was narrowed. This change was not seen to the same extent when the lumen of the ball valve connected to the inflow tube was narrowed by similar to 50%. More significant (P less than 0.005) acoustic changes were detected in P1 and P2 and R1 and R3, with the largest dB figs. in the lower frequency ranges in R1 and P2, when artificial clots and blood clots passed through the pump system. At higher frequencies, a significant change in dB figs. in R3 and P4 was detected when clots passed through the pump system. Acoustic monitoring of pump sounds may become a valuable tool in LVAD surveillance.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014
Keywords
Mechanical circulatory support; Frequency analysis; Thrombosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-112071 (URN)10.1111/aor.12244 (DOI)000343223400001 ()24372095 (PubMedID)
Available from: 2014-11-14 Created: 2014-11-13 Last updated: 2017-12-05Bibliographically approved
Tajik, B., Vidlund, M., Sundbom, P., Friberg, Ö., Holm, J., Vanky, F. & Svedjeholm, R. (2014). Intravenous glutamatereduces the need for inotropes in patients with heart failure after CABG foracute coronary syndrome?. In: : . Paper presented at 29th Annual meeting of the European Association of Cardiothoracic Anesthesiologists, Florence, Italy.
Open this publication in new window or tab >>Intravenous glutamatereduces the need for inotropes in patients with heart failure after CABG foracute coronary syndrome?
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2014 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-114367 (URN)
Conference
29th Annual meeting of the European Association of Cardiothoracic Anesthesiologists, Florence, Italy
Available from: 2015-02-19 Created: 2015-02-19 Last updated: 2015-11-09
Sundbom, P., Hübbert, L., Armeryd, T., Karlsson, M., Lindén, M. & Anderson, C. (2014). The place of skin cancer screening in heart transplant recipient follow-up protocols: a case series. In: Enliven: Surgery and Transplantation: . Paper presented at Enliven: Surgery and Transplantation (pp. 1-6).
Open this publication in new window or tab >>The place of skin cancer screening in heart transplant recipient follow-up protocols: a case series
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2014 (English)In: Enliven: Surgery and Transplantation, 2014, p. 1-6Conference paper, Published paper (Refereed)
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-114002 (URN)
Conference
Enliven: Surgery and Transplantation
Available from: 2015-02-05 Created: 2015-02-05 Last updated: 2015-11-09
Sundbom, P., Hedayati, E., Peterzén, B., Granfeldt, H., Casimir Ahn, H. & Hübbert, L. (2014). Young Woman With Breast Cancer and Cardiotoxicity With Severe Heart Failure Treated With a HeartMate II (TM) for Nearly 6 Years Before Heart Transplantation. ASAIO journal (1992), 60(6), E3-E4
Open this publication in new window or tab >>Young Woman With Breast Cancer and Cardiotoxicity With Severe Heart Failure Treated With a HeartMate II (TM) for Nearly 6 Years Before Heart Transplantation
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2014 (English)In: ASAIO journal (1992), ISSN 1058-2916, E-ISSN 1538-943X, Vol. 60, no 6, p. E3-E4Article in journal (Refereed) Published
Abstract [en]

Cardiotoxicity is a multifactorial problem, which has emerged with the improvement of cancer therapies and survival. Heart transplantation is relatively contraindicated in patients with breast cancer, until at least 5 years after complete remission. We present a case where a young woman who in 2001, at the age of 31, was diagnosed with breast cancer. She was considered cured, but 4 years later she suffered a relapse. During her second treatment, in 2006, she suffered from severe heart failure. She received a HeartMate II, as a long-term bridge to transplantation and 6 years later she was successfully transplanted. In this case report we discuss the use of mechanical circulatory support in cancer patients with drug-induced heart failure.

Place, publisher, year, edition, pages
Lippincott, Williams andamp; Wilkins, 2014
Keywords
breast cancer; cardiotoxicity; heart failure; mechanical circulatory support; heart transplantation
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-113018 (URN)10.1097/MAT.0000000000000138 (DOI)000345299200001 ()25232773 (PubMedID)
Available from: 2015-01-12 Created: 2015-01-08 Last updated: 2017-12-05
Sundbom, P., Hedayati, E., Peterzén, B., Granfeldt, H., Ahn, H. & Hübbert, L. (2013). Kardiotoxicitet med terminal hjärtsvikt och nästan sex år med Heartmate II i väntan på hjärttransplantation. In: : . Paper presented at Thoraxmötet 2013, 17-18 oktober, Linköping.
Open this publication in new window or tab >>Kardiotoxicitet med terminal hjärtsvikt och nästan sex år med Heartmate II i väntan på hjärttransplantation
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2013 (Swedish)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-104988 (URN)
Conference
Thoraxmötet 2013, 17-18 oktober, Linköping
Available from: 2014-03-05 Created: 2014-03-05 Last updated: 2015-11-09Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-5485-1052

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