Unusual indication for extracorporeal membrane oxygenation immediately after successful sequential bilateral lung transplantation: a case report.
BACKGROUND
Ischemia-reperfusion injury-induced primary graft dysfunction after lung transplantation is a major cause of early morbidity and mortality.


METHODS
We report an unusual case of primary graft dysfunction grade III following uneventful off-pump bilateral sequential lung transplantation caused by paradoxical left ventricular failure due to systolic anterior motion of the mitral valve-induced left ventricular outflow tract obstruction. Cardiac failure was precipitated by profound dehydration and administration of high doses of vasopressin and norepinephrine. Immediate connection to extracorporeal membrane oxygenation treated the graft failure-associated respiratory-pulmonary hypoxia and reversed the cardiogenic shock syndrome.


CONCLUSIONS
Hypovolemia together with a hyperdynamic state resulting from catecholamine administration may result in the development of dynamic left ventricular outflow tract obstruction even if baseline cardiac evaluation is unremarkable. Early detection and intensive efforts to reverse the underlying conditions including cessation of catecholamine therapy and correction of hypovolemia are essential.
Division of Transplantation, Section of General Thoracic Surgery, Florida Hospital Orlando, Orlando, Florida, USA; Department of Surgery, Section of General Thoracic Surgery, Florida Hospital Orlando, Orlando, Florida, USA. Electronic address: Hartmuth.Bittner.MD@flhosp.org.
H B
HB
Bittner
Division of Transplantation, Section of General Thoracic Surgery, Florida Hospital Orlando, Orlando, Florida, USA; Department of Surgery, Section of General Thoracic Surgery, Florida Hospital Orlando, Orlando, Florida, USA.
J H
JH
Boyer
Division of Transplantation, Section of General Thoracic Surgery, Florida Hospital Orlando, Orlando, Florida, USA.
B
B
Ledzian
Division of Transplantation, Section of General Thoracic Surgery, Florida Hospital Orlando, Orlando, Florida, USA; Department of Surgery, Section of General Thoracic Surgery, Florida Hospital Orlando, Orlando, Florida, USA.
R J
RJ
Moro
Division of Transplantation, Section of General Thoracic Surgery, Florida Hospital Orlando, Orlando, Florida, USA.
A
A
Pelaez
D015199:Extracorporeal Membrane Oxygenation; D006333:Heart Failure / Q000601:surgery; D006801:Humans; D020896:Hypovolemia / Q000209:etiology; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency; D011182:Postoperative Care; D055031:Primary Graft Dysfunction / Q000209:etiology*; D015427:Reperfusion Injury / Q000150:complications; D012770:Shock, Cardiogenic / Q000628:therapy