ABSTRACT
Neoplasms are among the most common solid-organ transplant complications, occurring in 11.7% of all transplant recipients and in 6% to 15% of heart transplant recipients, according to early studies. The skin and lips are the most common sites for neoplasms, but they also appear in the setting of post-transplant lymphoproliferative disease. Post-transplant lymphoproliferative disease (PTLD) is one of the most serious complications of long-term immunosuppression after transplantation. Herein we report the case of a 53-year-old man who underwent orthotopic heart transplantation for Chagas cardiomyopathy and had developed a mass in the left ventricle with symptomatic ventricle outflow obstruction. The patient was initially treated with anti-coagulation but his condition worsened and he was given emergency surgery to remove the mass. The patient recovered well and histologic assessment revealed PTLD as the etiologic culprit. Lymphoproliferative disorders are the second most frequently identified malignant neoplasm after heart transplantation. B-cell tumors are the most common histologically and are associated with infection by Epstein-Barr virus in 80% to 90% of cases.
Subject(s)
Chagas Cardiomyopathy/surgery , Heart Neoplasms/pathology , Heart Transplantation/adverse effects , Heart Ventricles/pathology , Lymphoproliferative Disorders/pathology , Chagas Cardiomyopathy/drug therapy , Electrocardiography , Fatal Outcome , Follow-Up Studies , Humans , Immunosuppressive Agents/therapeutic use , Lymphoproliferative Disorders/diagnostic imaging , Magnetic Resonance Spectroscopy , Male , Middle Aged , Nitroimidazoles/therapeutic use , Postoperative Complications/pathology , Recurrence , Time Factors , UltrasonographyABSTRACT
The use of the internal mammary artery (IMA) in coronary artery bypass graft surgery is an independent predictor of late survival in all subsets of patients and should not be denied to any subgroup. Therefore damage to the IMA during harvesting is a catastrophic complication after which the graft is usually discarded. We present here a simple and safe technique for repair of a damaged left IMA that allowed its rescue for grafting to the left anterior descending artery.
Subject(s)
Coronary Stenosis/surgery , Intraoperative Complications/surgery , Mammary Arteries/injuries , Myocardial Revascularization , Tissue and Organ Harvesting , Anastomosis, Surgical/methods , Coronary Stenosis/diagnostic imaging , Graft Occlusion, Vascular/diagnostic imaging , Humans , Male , Mammary Arteries/surgery , Middle Aged , Radiography , Suture TechniquesABSTRACT
Coronary artery bypass surgery (CABG) without cardiopulmonary bypass (CPB) may potentially reduce the number of microembolic signals (MES) associated with aortic manipulation or generated by the pump circuit, resulting in a better neurologic outcome after surgery. Our aim was to compare the frequency of MES and neurologic complications in CABG with and without CPB. Twenty patients eligible to routine CABG without CPB were randomized to surgery with CPB and without CPB and continuously monitored by transcranial Doppler. Neurologic examination was performed in all patients before and after surgery. The two groups were similar with respect to demographics, risk factors, grade of aortic atheromatous disease and number of grafts. The frequency of MES in the nonCPB group was considerably lower than in CPB patients, however, we did not observe any change in the neurologic examination during the early postoperative period. Neurologic complications after CABG may be related to the size and composition of MES rather than to their absolute numbers. A large prospective multicentric randomized trial may help to elucidate this complex issue
