Dynamic Cardiomyoplasty After Heart Transplantation
An Unusual Electrocardiogram
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.
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.
- Copyright © 1996 by American Heart Association