A 43-year-old patient with a history of HF diagnosed in 2005, secondary to cardiomyopathy, with severe systolic dysfunction, left ventricular ejection fraction (LVEF) 22%, with ICD implantation in 2006.
The patient was admitted to the emergency department with regular monitoring of her condition with fosinopril 5 mg, metoprol 50 mg, manifestations of nausea and vomiting
In May 2010, the patient was admitted to Mount Sinai Hospital in New York for a new episode of seizures requiring inotropic support with dobutamine and milna in high doses.
Six days later, the patient presented cardiorespiratory arrest in ventricular fibrillation. A recanis device was implanted with mechanical ventilation (MV), in situ annulus was performed with refractory ventricular arrhythmias.
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After implantation of the device, the patient presented right heart failure, with adequate response to intravenous furosemide and milrinone, with progressive regression of symptoms, being discharged 20 days after implantation.
After 5 months, the patient was readmitted again due to frequent ICD discharges secondary to ventricular tachycardia and atrial fibrillation with rapid ventricular response septum, which was attributed to contact of the device inlet cannula with the device.
HM II parameters were adjusted and treatment with amiodarone was started.
No significant arrhythmias occurred again.
Before discharge, an echocardiogram showed normal size left ventricle (LV) with LVEF 40%, severe right ventricular (RV) dysfunction, with minimal tricuspid regurgitation.
In subsequent controls, HF of right dominance reappeared, with progressive deterioration of its functional capacity.
Chile was assigned to the National Institute of Thoracic (INT) to enter the waiting list for HT in our country in May 2011.
The patient was clinically stable but with renal and hepatic dysfunction. She was treated with fosinopopemide, furosone, metoprolol, digoxin, acetylsalicylic acid and warfarin.
She was enlisted for HT, status IA.
(Thorax radiography, Figure 2).
The next day there was donation.
Right femoral cannulation was performed in the operating room for connection to extracorporeal circulation.
MH II extraction was very complex due to previous surgery and multiple adhesions were observed.
Orthotopic HT was performed with bicaval technique.
We used induction of immunosuppression with basiliximab (Siminephene®); Chile tritherapy with cyclosporine (Transporin®, Recalcine, Chile) mycolate mofetil (Linfonex®, vancomycin Re
The initial postoperative course was favorable.
She received vasoactive support with milrinone and isoproterenol.
MV weaning and extubation were achieved at 12 h without incidents.
1.
The day after the CBT and extensive right ileofemoral deep vein thrombosis occurred in relation to the cannulation site and fegmasia alba dolens.
She developed vasopressin distribute, with total creatinekinase levels over 30,000 IU/L, acute oligoanuric renal failure and, in parallel, severe shock, with a predominantly vasoprotective hemodynamic pattern, with high doses of drugs.
The patient was restarted on MV and continued renal replacement therapy with continuous venosus venosus was started.
Antibiotic coverage was increased with imipenem due to an intense unfavourable response.
Control echocardiography showed a dilated and hypokinetic RV, estimated LVEF 59% and mild pericardial effusion.
After 4 days of extreme severity, VAD was weaned, MV was removed and intermittent hemodialysis was performed.
Subsequently, he presented blood gas deterioration and febrile loops.
A chest scan showed extensive left pleural occupation, returning to the operating room for the evacuation of a hemothorax.
A fibrobronchoscopy with culture was performed, isolated.
It completed 21 days of antibiotic treatment with imipenem with adequate response.
The patient developed progressive improvement of the general condition, recovery of renal function, and dialysis was discontinued after 20 days.
Control echocardiography showed RV function recovery maintaining normal LVEF.
She started hospital rehabilitation and was discharged after 58 days in good general condition.
Currently, it is maintained in regular controls in INT, functional class I, with adequate graft function, without significant rejections after 24 months of cardiac transplantation.
