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Heterotopic Heart Retransplantation

Soulergues, Federico; Burgos, Claudio; Burgos, Pablo

doi: 10.1097/

Department of Cardiovascular Surgery and Transplantation, Hospital Italiano, Mendoza, Argentina.

Introduction: This clinical case study shows the importance of heterotopic heart transplantation (hHTX) and also the indications, evolution and complications of selected patients.

Materials and Methods: 17-year-old patient with celiac disease (CD) in his medical history with severe malnutrition at 2 years old, is referred to Hospital Regional in 2011 presenting edemas. He is diagnosed idiopathic dilated cardiomyopathy (IDC). His pulmonary vasoreactivity testing is negative and sildenafil is provided. He is referred to Hospital Italiano.

Echo: Ejection fraction (EF) 18%, moderate mitral insufficiency (MI); severe tricuspid insufficiency (TI) and pulmonary hypertension (PH) 70/46 and severe diffuse hypokinesis; right heart catheterization; pulmonary artery pressure 62/37; right atrium 17; transpulmonary gradient 14; cardiac output 3.8; systemic vascular resistance (VR) 1289; pulmonary VR 311. Diagnosis IDC and idiopathic PH. 6/02/12: First hHTX. PA pressure 85/45. Hospital Discharge: 24/02/12: patient stable. Immunosuppression and anticoagulation are indicated. Echo: native heart (NH): EF 11%, moderate TI and MI, PA pressure 40/27. Donated heart (DH): EF 58% 3/04/13: 18-year-old patient with CD in his medical history and hHTX gave up the diet, which caused gastroenteritis and bad absortion of the immunosuppresive drugs. He consults for dyspnea and the echo shows signs of acute cellular rejection. Electromechanical dissociation of the implant is determined and he’s put in a retransplantation waiting list. Evolution: 9/04/13: patient with inotropics provision. Echo: DH with an EF of 2% 12/04/13: DH EF of 2%, with a good EF of the NH and low PA pressure without an increase in the pulmonary VR. Therapeutic possibilities of treatment are considered according to the evolution of the patient to extract the DH, leave the NH or perform an orthotopic retransplantation. 15/04/13: patient with ventricular fibrillation of the DH has another echo done which shows a decrease in the EF of the NH with a measurement of 22%. He’s put in national emergency for a HTx. 11/05/13: Second hHTX is done. PA pressure 90/60.

Results: Hospital discharge: 12/06/13: patient stable. Echo: EF 20% of the DH, PA pressure 37/30. Donated heart EF 55%. Immunosuppression and anticoagulation are indicated.

Conclusion: Results show that hHTX is still a viable option among a population of selected patients with good overall results.

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