Search

The article reports a case of Takotsubo cardiomyopathy in an elderly woman after elective coronary artery bypass surgery and bioprosthetic aortic valve replacement for severe aortic valve stenosis. There was no preoperative cognitive impairment, with hypothyroidism as the only medical comorbidity. Takotsubo cardiomyopathy may allegedly represent another complication of postoperative delirium.

Liver disease develops in one-third of patients with cystic fibrosis ( CF). It is rare for liver disease to have its onset after 20 years of age. Lung disease, however, is usually more severe in adulthood. A retrospective analysis was performed on nine patients. Three patients required lung transplantation approximately a decade after liver transplant, and another underwent combined liver and lung transplants. Four additional patients with liver transplants are awaiting assessment for lung transplants. One patient is awaiting combined liver and lung transplants. With increased survival in CF, several patients may require more than single organ transplantation. [ABSTRACT FROM AUTHOR]

Purpose: Donation after cardiac death (DCD) from Maastrict category 3 donors consisted of approximately 12% of our lung transplant activity in 2008. We will review the results of our DCD lung transplants and discuss the future direction of the program at St Vincent's Hospital. Methodology: Since commencing in November 2007 there have been 19 referrals for DCD, leading to 9 attempted retrievals. Only seven retrievals resulted in lung donation. Elective withdrawal of life-sustaining support and certification of death (limit of 60 minutes from withdrawal) occurred in the Intensive Care Unit or Operating Theatre. Results: The donor group average age was 34 years (range 14–56) and average PaO2/FiO2 ratio 407 (±57). Causes of death included subarachnoid haemorrhage (2), Traumatic head injury (2), hypoxic brain injury (2) and embolic CVA (1). Average recipient age was 32 years (range 15–61) and aetiology of respiratory failure included cystic fibrosis (2), bronchiectasis (1), bronchiolitis obliterans (1), emphysema (1), interstitial lung disease (1) and pulmonary hypertension (1). Mean time to asystole after withdrawal of treatment was 23 minutes (range 9–57), mean warm ischaemic time 19 minutes (range 10–31) and mean cold ischaemic time (left lung) 275 minutes (range 241–320). Early gas exchange was good: an average PaO2/FiO2 of 324 (141–503). Average intensive care stay was 5 days (3–10) and length of stay 23 days (12–36). All patients are still alive. Conclusion: Despite the period of warm ischaemia the early results are excellent. Future challenges will present when the program considers donors with longer warm ischaemic times and more “marginal” gas exchange. [ABSTRACT FROM AUTHOR]