Circulation. 1996;93:2204
(Circulation. 1996;93:2204.)
© 1996 American Heart Association, Inc.
Dynamic Cardiomyoplasty After Heart Transplantation
An Unusual Electrocardiogram
Angel L. Fernández González, MD, PhD;
Jesús M. Herreros, MD, PhD;
Eduardo Alegría, MD, PhD;
María Amparo Martínez, MD;
Ignacio Iglesias, MD, PhD
From the Departments of Cardiovascular and Thoracic Surgery and
Cardiology, University Clinic of Navarra, School of Medicine, University of
Navarra, Pamplona, Spain.
Correspondence to Angel L. Fernández González, MD, PhD, Department of Cardiovascular and Thoracic Surgery, University Clinic of Navarra, 31008 Pamplona, Spain.
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Introduction
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 Top
 Introduction
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A 70-year-old man with ischemic
cardiomyopathy underwent heart
transplantation in
July 1990. The postoperative course was uneventful,
and the patient
maintained normal systolic and diastolic
ventricular
function and New York Heart Association (NYHA)
functional class
I. In March 1993, after an episode of diarrhea, the
patient
was admitted with signs and symptoms of heart failure. The
echocardiogram
showed a left ventricular ejection fraction
of 20%. A cardiac
biopsy showed severe acute allograft rejection. The
patient
received high doses of pulsed corticosteroids,
and a repeat
biopsy 12 days later confirmed resolution of the rejection
episode.
Nevertheless, signs and symptoms of
severe heart failure persisted
despite vasodilator and inotropic
treatment. Cardiac angiography
revealed global depression of
ventricular systolic function,
with a left
ventricular ejection fraction of 22%. The coronary
arteries
were normal, without signs of allograft vasculopathy.
Retransplantation
was not considered because of advanced age and serum
creatinine
>3.5 mg/dL. In July 1993, a dynamic
cardiomyoplasty with
the latissimus dorsi muscle was performed. At
present, the patient
is in NYHA functional class II. The left
ventricular ejection
fraction either by ultrasound or
radionuclide studies is 25%
with the cardiomyostimulator off and 30%
with the cardiomyostimulator
on.
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Figure 1. Three-channel ECG performed 12 months after dynamic
cardiomyoplasty. There are two different p waves. Arrows indicate p
waves of the native heart. Arrowheads indicate pulse train of the
cardiomyostimulator programmed with a frequency ratio of 3:1.
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Footnotes
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The editor of Images in Cardiovascular Medicine is Hugh A. McAllister,
Jr, MD, Chief, Department of Pathology, St Luke's Episcopal
Hospital and Texas Heart Institute, and Clinical Professor of
Pathology, University of Texas Medical School and Baylor College
of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner, MC 4-265, Houston, TX 77030.
