Limb ischemia after heart transplantation: an unusual case of tissue embolism

Major complications of heart transplantation include graft rejection, infection, graft arteriosclerosis, malignancy, and drug toxicity. Among these complications, infections and thrombophilic disorders are of particular interest owing to their major contribution to morbidity and mortality among heart transplantation patients. Thrombophilic disorders are caused by imbalance between hypercoagulation and fibrinolytic states. In this report, we describe a 43-year-old man who had unusual complications of heart transplantation. We presume that the unusual postoperative complications of the patient might have been caused by a faulty surgical procedure, improper use of anticoagulant agents, and incomplete prophylaxis for infections. During the postoperative period, the patient suffered arterial obstruction three times, for which he underwent clot removal via embolectomy. In addition to arterial obstruction, the patient had a mobile mass in the left atrium that was removed by open cardiac surgery. The frozen sample of the cardiac mass was positive for Acinetobacter baumannii. After 7 days of observation in the hospital and proper antibiotic regimen, the patient was sent home with no additional complaints and normal physical examination. We conclude that in heart transplantation patients, the precise performance of the surgical procedure, postoperative care, and early removal of the embolus might reduce morbidities and mortality due to thrombophilic disorders

Refractory vasoplegic syndrome in an adult patient with infective endocarditis: a case report and literature review

Postoperative vasoplegic syndrome [VS] is characterized by low systemic vascular resistance, normal or elevated cardiac output, and poor response to volume expansion. The incidence ofVS after cardiac surgery requiring cardiopulmonary bypass is about 20%. Sometimes, VS becomes refractory and initial treatments do not work, rendering treatment a great challenge. In this study, we describe a young male patient with endocarditis undergoing tricuspid valve replacement. When being weaned off cardiopulmonary bypass, the patient experienced VS. The patient s blood pressure did not increase after the administration of a high dose of epinephrine and norepinephrine. Therefore, he was commenced on a low dose ofvasopressin and gradually his blood pressure reached the normal range. Although the standard management of VS is a high dose ofvasopressors, this patient was refractory to a combination of epinephrine and norepinephrine; only a vasopressin infusion was able to treat the patient. Eventually, he was weaned from bypass and the operation was terminated satisfactorily

Thereafter, the patient passed the recovery period in the cardiac intensive care unit and was discharged. It seems that vasopressin is an excellent option in refractory vasoplegia with minimal response to other vasopressors

[Ten-year evaluation of cardiac myxoma in Shahid Modarres Hospital]

Background: Primary cardiac tumors are rare tumors which should be operated urgently. In this study, cardiac myxoma have been evaluated from diagnosis until discharge in a 10 years period and then results including presenting symptoms, approach to the patients were compared with similar study in this center a decade ago

Methods: Patients who underwent operation for myxoma from year 2003 until 2013 in the Shahid Modarres Hospital were included in this study

Results: Eighteen patients included in the study, 11 female and seven male. Patients' ages were in the range of 13 to 76 years [mean 53 years]

Mean time from diagnosis to operation was 5.8 days and mean time from surgery to discharge was 8.6+/-6.1 days. Most common presenting symptoms were first clinical presentation in four patients. In all patents echocardiography was the main diagnostic modality. In addition to trans thoracic echocardiography [TTE], in five patients TEE was used and in 13 patients coronary angiography was used to rule out concomitant coronary artery disease. 94.4% of all tumors [17 cases] were primary cardiac tumors and only one tumor [5.6%] was recurrent. In 16 patients [88.9%] tumor were found in the Left Atrium [L.A] and in one case, tumor was found in both atria and in another case, tumor was in the ventricle. After tumor excision, atrial septum was repaired primarily in seven cases [38.9%] and with pericardial patch in 9 cases. One patient underwent concomitant coronary artery bypass graft [CABG] and another patient underwent concomitant pulmonary valve repair. 14 patients [77.8%] discharged from hospital without any post operative complication. Heart block occurred in one patient and cerebral emboli with secondary cere-brovascular accident [CVA] developed in two patients. One patient died [5.6%]

Conclusion: Comparing results from two similar studies in two consecutive decades revealed that mean time from diagnosis to operation obviously was reduced but advances in diagnostic modalities were unable to change clinical presentation or reduce age of tumor diagnosis or complications or size