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The article presents a clinical case of tuberculosis during the dru g-i nduced immunosuppression after orthotopic heart transplantation. The ant i-t uberculosis therapy in combination with immunosuppressive drugs is described. The course of tuberculosis in the patient was characterized by rapid changes of clinical and radiological signs, both negative and positive with the administration of adequate chemotherapy. The clinical management of this patient required skills of emergency care for lif e-t hreatening conditions and command of procedures aimed to prevent their development.

Two heart transplant patients aged 80 and 83 years with recurrent heart failure due to severe tricuspid regurgitation are reported. In view of their high perioperative risk, both patients underwent percutaneous transcatheter edge-to-edge tricuspid valve repair, and both experienced excellent technical success, with favorable 2-year clinical outcome. (Level of Difficulty: Advanced.), Central Illustration

Background Persistent left superior vena cava is a not uncommon congenital vascular abnormality. We report a case of heart transplantation with reconstruction of persistent left superior vena cava using a prosthetic vascular graft. Case presentation A 20-year-old man with idiopathic dilated cardiomyopathy and persistent left superior vena cava underwent orthotopic heart transplantation 2 years and 3 months after left ventricular assist device implantation. Because the persistent left superior vena cava had a larger diameter than the right superior vena cava, the transected persistent left superior vena cava was reconstructed with a prosthetic vascular graft anastomosed to the free wall of the right atrium. Postoperative enhanced computed tomography revealed good patency of the graft. The patient’s postoperative course has been uneventful during 2 years of follow-up, despite the risk of complications. Conclusions Reconstruction of a persistent left superior vena cava with a prosthetic vascular graft may be one option at the time of heart transplantation.

We report a 6-year-old with single ventricle physiology secondary to tricuspid atresia who had cardiorespiratory failure who was not a candidate for further single ventricle palliation. The patient underwent planned staged left pneumonectomy for recurrent pneumonias secondary to bronchomalacia followed by orthotopic heart transplantation. This aggressive approach improved the patient candidacy for heart transplantation by removing the source of recurrent infection and respiratory failure (left lung).

Outside of heart and lung transplantation, only few cases have been reported describing venoarterial extracorporeal membrane oxygenation (VA-ECMO) use in solid organ transplantation. We present a case of a staged combined heart–kidney transplant in which VA-ECMO was utilized after a complicated orthotopic heart transplantation to successfully complete the subsequent renal transplantation.

Patients with terminal heart failure, refractory to drug therapy, are severe category of cardiology. The possibility of effective correction of multi-organ failure and an increase in the life-time of patients with critical cardiac insuffi ciency has been proved with the use of biventricular assist device (BiVAD). In this report, we present the case of implantation of the BiVAD «Berlin Heart EXCOR» as a bridge to orthotopic cardiac transplantation to a patient with dilated cardiomyopathy, critical heart failure and a high risk of fatal complications. Despite the complex, long postoperative period after the implantation of «Berlin Heart EXCOR», proceeded with reversible multiorgan and heart failure, dysfunction of BiVAD pumps, it was achieved patient’s recovery, regress of heart failure phenomena and orthotopic heart transplantation was performed after 9 months with a good long-term result.

At 22 years following heart transplantation, a patient presented with incessant atrial flutter. During electrophysiologic study, 2 simultaneous atrial…, At 22 years following heart transplantation, a patient presented with incessant atrial flutter. During electrophysiologic study, 2 simultaneous atrial arrhythmias were mapped, 1 from the donor and 1 from the recipient’s heart. High-density mapping allowed for rapid identification of electrically abnormal areas, which were successfully ablated, thus restoring sinus rhythm. (Level of Difficulty: Advanced.), Graphical abstract

BackgroundCardiac sympathetic denervation (CSD) has been shown to reduce the burden of implantable cardioverter-defibrillator (ICD) shocks in small series of patients with structural heart disease (SHD) and recurrent ventricular tachyarrhythmias (VT).ObjectivesThis study assessed the value of CSD and the characteristics associated with outcomes in this population.MethodsPatients with SHD who underwent CSD for refractory VT or VT storm at 5 international centers were analyzed by the International Cardiac Sympathetic Denervation Collaborative Group. Kaplan-Meier analysis was used to estimatefreedom from ICD shock, heart transplantation, and death. Cox proportional hazards models were used to analyze variables associated with ICD shock recurrence and mortality after CSD.ResultsBetween 2009 and 2016, 121 patients (age 55 ± 13 years, 26% female, mean ejection fraction of 30 ± 13%) underwent left or bilateral CSD. One-year freedom from sustained VT/ICD shock and ICD shock, transplant, and death were 58%and 50%, respectively. CSD reduced the burden of ICD shocks from a mean of 18 ± 30 (median 10) in the year before study entry to 2.0 ± 4.3 (median 0) at a median follow-up of 1.1 years (p< 0.01). On multivariable analysis, pre-procedure New York Heart Association functional class III and IV heart failure and longer VT cycle lengths were associated with recurrent ICD shocks, whereas advanced New York Heart Association functional class, longer VT cycle lengths, and a left-sided-only procedure predicted the combined endpoint of sustained VT/ICD shock recurrence, death, and transplantation. Of the 120 patients taking antiarrhythmic medications before CSD, 39 (32%) no longer required them at follow-up.ConclusionsCSD decreased sustained VT and ICD shock recurrence in patients with refractory VT. Characteristics independently associated with recurrence and mortality were advanced heart failure, VT cycle length, and a left-sided-only procedure.

Key Clinical Message We report a first case of a highly complicated lead extraction in a young man who previously underwent orthotopic heart transplantation (OHT).Lead extraction in transplanted patients may be a feasible and safe procedure in order to maintain a low infective risk and to preserve alternative vascular access sites.

BackgroundA 75-year-old woman with a past medical history significant for non-ischaemic cardiomyopathy status post orthotopic heart transplant, type II diabetes mellitus, hypertension, chronic kidney disease stage III, chronic anaemia, and chronic diarrhoea presented with nausea, vomiting, and an unexplained fall 23 years after original transplantation.Case summaryDuring her hospital stay, she had multiple episodes of sinus arrest with syncope, preceded by seizure like activity. She was stabilized, and broad work up revealed an occult brain mass that was ultimately resected and consistent with post-transplant lymphoproliferative disease.DiscussionFeatures that make this case study unique include the late onset and location of the malignancy, the absence of Epstein–Barr virus involvement, and asystole that was potentially neurologically mediated and induced by a brain space occupying mass. This case offers insight into potential late parasympathetic reinnervation of transplanted hearts, adds to the growing literature regarding the connection between the brain and the heart, and reviews potential complications in patients with a remote history of heart transplantation.

Coronary fibromuscular dysplasia is uncommon, and even rarer its unstable and recurrent course. We present the unique case of a 52‐year‐old woman who underwent in total 12 coronary angiographies and three percutaneous coronary intervention within 24 months because of repetitive acute coronary syndromes due to refractory spasm, dissection, restenosis all leading to end‐stage heart failure, and heart transplantation. The patient died 12 days after the heart transplantation complicated by intraoperative acute thrombotic occlusion of left anterior descending artery of the graft despite normal pretransplant coronary angiography. Autopsy of the recipient heart confirmed coronary fibromuscular dysplasia with massive intimal hyperplasia and restenosis.

Atrial tachycardia (AT) after orthotopic heart transplantation (OHT) can be complex, occurring in the recipient as well as in the donor atria. Catheter ablation of these multiple ATs is challenging because of the complexity of atrial scar substrates. This case report demonstrates the merit of using a novel multipolar high-density mini-basket mapping catheter for fast, high-resolution mapping of 3 different ATs occurring in both atria of the orthotopic transplant heart.

Aim: to assess the relationship between preand post-transplantation factors and degree of coronary artery lesion, reported by intravascular ultrasound study (IVUS) in patients who underwent orthotopic heart transplantation (OHT) surgery. Materials and methods. The study comprised of 27 patients who underwent OHT more than 2 years before. The age of patients was 46,8 ± 10,4 years old. All of them were preoperatively classified by HLA system. All patients received transthoracic echocardiography at terms of 1, 6, 12 and 24 months after OHT. Coronary angiography (CAG) and IVUS were performed at 24 ± 6 months. Results. In CAG none of the patients showed angiographic signs of CA stenosis, but changes of various degrees were detected by IVUS. Results obtained by IVUS were clustered to select two groups with different degree of coronary artery lesion. The donor’s age in Group 2 was evidently higher compared to Group 1 (34,77 ± 1,03 and 40,00 ± 2,04 years, respectively, p = 0,043). Donor-recipient coincidence frequency was lower in group with significant CA lesion (by 2,36, р = 0,003). The number of cardiac surgeries performed prior to OHT was higher in Group 2 (by 2,8, р = 0,008). Post-transplant factor analysis showed that the number of diabetes mellitus (DM) cases revealed after transplantation was more frequent in Group 2 (by 3,2 vs Group 1, р = 0,021). Conclusion. The degree of CA lesion according to IVUS at 24-month period after OTH was associated with several post-transplant factors, which were the presence of cardiac surgical interventions before transplantation, low HLA donor-recipient coincidence frequency, and donor’s age. The more significant CA lesion is, the more cases of DM after OHT occur.

Popisujeme připad AL amyloidozy spolu s izolovaným postiženim myokardu. Vzhledem k obrazu refrakterniho srdecniho selhani byla u pacienta provedena ortotopicka transplantace srdce. U srdecniho stěpu byla zjistěna významna infiltrace středni vrstvy srdecni stěny. O deset měsiců později byla u pacienta provedena transplantace autolognich kmenových buněk s přiznivým výsledkem. Tento připad dokazuje, že ortotopicka transplantace srdce s naslednou transplantaci autolognich kmenových buněk u vysoce selektovaných pacientů s AL amyloidozou je život zachraňujicim výkonem.

Cardiac allograft vasculopathy is a major cause of morbidity and mortality in orthotopic heart transplantation. The optimal management remains uncertain, especially in left main coronary artery lesions. With the limited data available in the literature, we present a review of three pediatric cases of cardiac allograft vasculopathy, involving the left main coronary artery, treated with percutaneous coronary intervention.

We describe the unique case of a heart transplant patient with type I atrial fibrillation that arose in the donor atrium during a late acute rejection episode and conducted to the recipient atrium with second-degree type I local block. After internal cardioversion, programmed stimulation showed bidirectional decremental conduction across the suture line with nearly equal atrioatrial interval, whereas the recipient atrium showed progressively delayed intra-atrial conduction. These findings strongly suggest that the mechanism of atrioatrial conduction may be electrical propagation along viable myocardium bridging the surgical scar and that the electrophysiologic characteristics of the recipient atrium are involved in decremental conduction across the suture line.

Objectives: This study evaluated the feasibility, tolerability, and efficacy of a strategy for percutaneous intra-aortic balloon pump (IABP) placement through the left axillary-subclavian artery to provide mechanical circulatory support in patients with end-stage heart failure as a bridge to heart transplantation. Background: The transfemoral approach to IABP placement is associated with major disadvantages, including the risk for infection and limitation of patient mobility in those requiring extended support. Methods: We developed a percutaneous technique for placing IABPs in the left axillary artery that permits upright sitting and ambulation. We performed a retrospective review of data from patients who had undergone left axillary IABP implantation between 2007 and2012. Results: Fifty patients who received a left axillary IABP as a bridge to transplantation were identified, of whom 42 (84%) underwent heart or heart-multiorgan transplantation. Cumulative survival on IABP support was 92%, and post-transplant 90-day survival was 90%. Median duration of support was 18 days. Four of 50 patients (8%) died while on IABP support, and 3 (6%) received greater mechanical circulatory support. Four patients (8%) had clinically significant thromboembolic or bleeding events without long-term sequelae. The most common minor adverse event was IABP malposition, in 22 patients (44%). Prolonged IABP support in the heart-transplantation cohort was associated with significant improvements in mean pulmonary artery pressure and in creatinine and total bilirubin concentrations. Conclusions: Percutaneous insertion of an IABP through the left axillary artery is a feasible and relatively well-tolerated strategy tobridge patients with end-stage heart failure to heart transplantation. This form of mechanical-device treatment permits upright sitting and ambulation in those requiring extended support. © 2013 American College of Cardiology Foundation.

Heart transplantation is an accepted therapeutic modality for end-stage congenital heart disease for both biventricular and univentricular anomalies. Many transplant centers have pushed the limits of transplantation to include patients with high pulmonary vascular resistance, high panel reactive antibodies, positive cross-matches, and ABO-incompatibility. Excellent results have been possible, particularly with the development of improved diagnostic and therapeutic algorithms to prevent and treat rejection, infection, and post-transplant lymphoproliferative disease. Late graft failure and chronic rejection remain vexing problems. The vast majority of patients with biventricular congenital heart disease have undergone prior cardiac surgical procedures. Indications for transplantation in this subgroup are primarily progressive refractory heart failure following prior cardiac surgical reconstructive procedures. Contraindications to transplantation mimic those for other forms of end-stage heart disease. A determination of pulmonary vascular resistance is important in listing patients with biventricular congenital heart disease for heart transplantation. Modifications in the implant technique are necessary and vary depending on underlying recipient anatomy. Risk factors for perioperative outcomes in patients with biventricular congenital heart disease include the need for reoperation, the degree of anatomic reconstruction necessary during the implant procedure, and the degree of antibody sensitization, in addition to a number of other recipient and donor factors. Postoperative outcomes and survival are very good but remain inferior to those with cardiomyopathy in most series. In conclusion, patients with end-stage biventricular congenital heart disease represent a complex group of patients for heart transplantation, and require careful evaluation and management to ensure optimal outcomes.

Fulminant myocarditis has been defined as the clinical manifestation of cardiac inflammation with rapid-onset heart failure and cardiogenic shock. We report on the case of a 23-yr-old woman with pathology-proven fulminant lymphocytic myocarditis presenting shock with elevated cardiac troponin I and ST segments in V1-2, following sustained ventricular tachycardia and a complete atrioventricular block. About 55 min of intensive cardio-pulmonary resuscitation, with extracorporeal membrane oxygenation support, bridged the patient to orthotopic heart transplantation. The explanted heart revealed diffuse lymphocytic infiltration and myocyte necrosis in all four cardiac chamber walls. Aggressive mechanical circulatory support may be an essential bridge for recovery or even transplantation in patients with fulminant myocarditis with shock. Graphical Abstract

Aim. To evaluate dynamic of physical capability (PC) based on bicycle ergometry test data in different post- operation terms after orthotopic heart transplantation (OHT). Methods and results . In 28 patients aged from 19 to 59 (mean 45,9 ± 2,2) years the dynamics of PC values was assessed at 14–36 (mean 20,8 ± 1,6) months after OHT. Prior to surgery, all 28 patients had low exercise tolerance (ET) as well as low maximal oxygen consump- tion (VO 2max ). A signi fi cant increase in ET and VO 2max was registered in 6 and 12 months after OHT compared to baseline ( р < 0,05), a trend to increasing PC values was noted in 6 to 12 months after OHT compared to baseline, 3 (20%) of 15 patients examined showed myocardial ischemia . Conclusion. The PC decrease revealed in 14–36 months after OHT may be indicative of vasculopathy development or progressive underlying athero- sclerotic process.

Orthotopic heart transplantation (OHT) is currently the most effective long-term therapy for patients with end-stage cardiac disease, even as left ventricular devices show markedly improved outcomes. As surgical techniques and immunosuppressive regimens have been refined, short-term mortality caused by sepsis has decreased, while morbidity caused by repeated rejection episodes and vasculopathy has increased, and is often manifested by arrhythmias. These chronic transplant complications require early and aggressive multidisciplinary treatment. Understanding the relationship between arrhythmias and these complications in the acute and chronic stages following OHT is critical in improving patient prognosis, as arrhythmias may be the earliest or sole presentation. Finally, decentralised/denervated hearts represent a unique opportunity to investigate the underlying mechanisms of arrhythmias.