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Cardiac transplantation 

Cardiac transplantation
Chapter:
Cardiac transplantation
Author(s):

Filip Kucera

DOI:
10.1093/med/9780198759447.003.0007
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date: 13 April 2021

A 4-year-old girl was diagnosed with idiopathic dilated cardiomyopathy and started on medical therapy. Following stability for several weeks, she was readmitted for significant symptoms of worsening of heart failure. There was limited improvement on intravenous diuretics and, as such, was unable to be weaned off intravenous inotropic support. She was therefore listed for ventricular assist device insertion as a bridge to cardiac transplant. She was urgently listed for a heart transplant. The post-operative course after Berlin Heart left ventricular assist device implantation was uneventful, and within a short while, she was transferred to the cardiac ward. Two months later, despite appropriate anticoagulation, she had symptoms of left-sided weakness as a result of an ischaemic stroke. Fortunately, she made a full recovery. She received a donor heart and, following transplantation, was admitted to cardiac intensive care on adrenaline and milrinone. Despite initial signs of mild cardiac dysfunction on echocardiography, her cardiac function normalized within a few days. In addition, she was treated with medical therapy for early post-transplant hypertension. The first cardiac biopsy showed no signs of rejection and she had no evidence of cytomegalovirus or Epstein–Barr virus infection. After 10 days, she was transferred back to the cardiology ward and was subsequently discharged home, with follow-up in the transplant clinic. Three months later, she returned back to school.

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