[High-risk pulmonary surgery in potential candidates for a heart transplant].
Severe ventricular dysfunction and concomitant infection are considered absolute contraindications for major thoracic operations and immunosuppressive therapy, respectively. However, cardiac transplantation represents the first-choice treatment in advanced heart failure. We report the case of a patient with dilated cardiomyopathy and severe left ventricular dysfunction (ejection fraction = 25%), initially not considered as a potential heart transplant candidate due to the presence of a lung abscess. The patient subsequently underwent atypical pulmonary resection with intraoperative and perioperative intraaortic balloon counter-pulsation for circulatory support and was then listed for cardiac transplant. Pitfalls and intra/postoperative strategy, all of which are potentially important aspects in minimizing operative risk, are discussed.
Donatelli
F
F
Istituto di Malattie dell'Apparato Cardiovascolare e Respiratorio, Università degli Studi di Milano.
Pocar
M
M
Marchetto
G
G
Moneta
A
A
Villa
E
E
Grossi
A
A
D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000601:surgery; D000075202:Contraindications; D006333:Heart Failure / Q000150:complications / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D008169:Lung Abscess / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011654:Pulmonary Edema / Q000601:surgery; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000601:surgery