ABSTRACT
A 24-year-old man underwent orthotopic heart transplantation for treatment of end-stage complex congenital heart disease. Six weeks postoperatively, five erythematous skin lesions developed on the patient's right forearm. Punch biopsy revealed Aspergillus. Despite extensive testing, no other potential primary site was located. Because of concern of dissemination, the patient was treated with a combination of local debridement and systemic antifungal therapy with itraconazole. He is presently without signs or symptoms of recurrent disease.
Subject(s)
Antifungal Agents/therapeutic use , Aspergillosis/therapy , Dermatomycoses/therapy , Heart Transplantation/immunology , Ketoconazole/analogs & derivatives , Adult , Aspergillosis/immunology , Combined Modality Therapy , Debridement , Dermatomycoses/immunology , Humans , Immunosuppression Therapy/adverse effects , Itraconazole , Ketoconazole/therapeutic use , MaleABSTRACT
A 39-year-old potential heart transplant recipient had a right lower lobe infiltrate and on pulmonary angiography was found to have an embolous to the common basilar artery. This was successfully managed by a right lower lobectomy, after aggressive medical management failed. The patient was treated postoperatively with antibiotics and subsequently underwent orthotopic heart transplantation. At 1 year after transplant the patient has no evidence of cardiac or pulmonary insufficiency.
Subject(s)
Heart Transplantation , Pneumonectomy , Pulmonary Embolism/surgery , Adult , Humans , Male , Pulmonary Embolism/diagnostic imaging , RadiographyABSTRACT
Donor sinus node dysfunction is an uncommon event after orthotopic heart transplantation. In the past treatment of persistent symptomatic bradycardia in the setting of orthotopic heart transplantation has been accomplished by implantation of a single transvenous lead system with loss of atrioventricular synchrony and rate responsiveness or by implantation of a multiple transvenous lead system in which the multiple leads present a mechanical limitation to endomyocardial biopsy. To preserve atrioventricular synchrony, avoid the mechanical limitations of a ventricular lead at the time of routine biopsies, and maintain some degree of rate responsiveness during exercise, we elected to implant an activity-detecting pacing system with a single bipolar transvenous atrial lead in two of our orthotopic heart transplant recipients with persistent symptomatic donor sinus node dysfunction. This article details the techniques used and the results obtained in what we believe to be the first two implantations of this unique pacing system in orthotopic heart transplant recipients.
