Stroke and myocardial infarction as late complications of lung transplantation.
A 64-year-old man who had received a lung transplant later presented with an air embolism that caused ST-segment elevation myocardial infarction, multiple strokes, and death. Transesophageal echocardiography was used to document air bubbles crossing from a bronchial fistula to a pulmonary vein and into the left atrium. Spontaneous air was seen entering a pulmonary vein during positive-pressure ventilation and exiting through the left ventricular outflow tract. Autopsy confirmed the presence of a probe-patent bronchial-to-pulmonary vein fistula within a focus of necrosis and infection with Aspergillus flavus, an angioinvasive organism. The potential for intravascular gas arising from the anastomotic site should be considered when transplant recipients who present with myocardial or peripheral arterial infarction are evaluated.
Johnston
Samuel Lewis
SL
Department of Internal Medicine, Division of Cardiology, Loyola University Medical Center, Maywood, Illinois 60153, USA. sjohnst@lumc.edu
Halabi
Sahar
S
Cohoon
Kevin
K
Alex
Charles
C
Hutchens
Kelli
K
Leya
Fred
F
D000714:Anastomosis, Surgical / Q000009:adverse effects; D001228:Aspergillosis / Q000150:complications; D001231:Aspergillus flavus; D001983:Bronchial Fistula / Q000175:diagnosis / Q000382:microbiology / Q000473:pathology; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D004618:Embolism, Air / Q000000981:diagnostic imaging / Q000209:etiology; D017809:Fatal Outcome; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology*; D011667:Pulmonary Veins / Q000473:pathology; D020521:Stroke / Q000209:etiology*; D013997:Time Factors; D000267:Tissue Adhesions / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014652:Vascular Diseases / Q000175:diagnosis / Q000382:microbiology / Q000473:pathology