Heart Transplantation Complicated by COVID-19 Infection.

The influence of Coronavirus-2019 (COVID-19) on heart transplantation is considerable. Reports of COVID-19 infection in recently transplanted patients are scarce. We present a 60-year-old male patient with COVID-19 infection, diagnosed 6 days after transplantation. His clinical course revealed 2 phases. Initially, there were mild respiratory symptoms for which he was treated with remdesivir and noninvasive respiratory support. In a second phase with clinical deterioration on postoperative day 22, further respiratory decline led to the administration of convalescent plasma, with satisfactory response and further improvement of his condition.

Supportive and Palliative Care Indicators Tool prognostic value in older hospitalised patients: a prospective multicentre study.

BACKGROUND: An increasing number of older patients are hospitalised. Prognostic uncertainty causes hospital doctors to be reluctant to make the switch from cure to care. The Supportive and Palliative Care Indicators Tool (SPICT) has not been validated for prognostication in an older hospitalised population. AIM: To validate SPICT as a prognostic tool for risk of dying within one year in older hospitalised patients. DESIGN: Prospective multicentre study. Premorbid SPICT and 1-year survival and survival time were assessed. SETTING/PARTICIPANTS: Patients 75 years and older admitted at acute geriatric (n=209) and cardiology units (CUs) (n=249) of four hospitals. RESULTS: In total, 59.3% (124/209) was SPICT identified on acute geriatric vs 40.6% (101/249) on CUs (p<0.001). SPICT-identified patients in CUs reported more functional needs and more symptoms compared to SPICT non-identified patients. On acute geriatric units, SPICT-identified patients reported more functional needs only.The HR of dying was 2.9 (95% CI 1.1 to 8.7) in SPICT-identified versus non-identified after adjustment for hospital strata, age, gender and did not differ between units. One-year mortality was 24% and 22%, respectively, on acute geriatric versus CUs (p=0.488). Pooled average sensitivity, specificity and partial area under the curve differed significantly between acute geriatric and CUs (p<0.001), respectively, 0.82 (95%CI 0.66 to 0.91), 0.49 (95%CI 0.40 to 0.58) and 0.82 in geriatric vs 0.69 (95% CI 0.42 to 0.87), 0.66 (95% CI 0.55 to 0.77) and 0.65 in CUs. CONCLUSIONS: SPICT may be used as a tool to identify older hospitalised patients at risk of dying within 1 year and who may benefit from a palliative care approach including advance care planning. The prognostic accuracy of SPICT is better in older patients admitted at the acute geriatric versus the CU.

Minimally Invasive Repair of Mitral Valve Prolapse and Concomitant Atrial Fibrillation Ablation in a Heart Transplant.

Significant mitral valve disease with atrial fibrillation after heart transplantation is unusual. We report the diagnosis and minimally invasive surgical treatment 17 years after transplantation, in which mitral valve repair together with left atrial ablation was performed, resulting in a satisfying clinical and echocardiographic improvement.

Alcohol and drugs: twins or evil in a young heart.

We describe how the use of multiple drugs and excessive alcohol intake caused a dilated cardiomyopathy complicated by cardiogenic shock and life-threatening ventricular arrhythmias in an otherwise healthy young man. The diagnosis was made by exclusion of other causes of cardiomyopathy. Surprisingly an ischaemic scar without significant coronary artery disease was also found on cardiac MRI, most likely related to vasoactive drugs (cocaine). An ICD was implanted during the same hospital stay after careful assessment of the risk of recurrent ventricular arrhythmias and sudden cardiac death.