Elsevier

Transplantation Proceedings

Volume 47, Issue 7, September 2015, Pages 2291-2294
Transplantation Proceedings

Case reports in transplantation
Cardiac
Total Artificial Heart Bridge to Transplantation for a Patient With Occult Intracardiac Malignancy: Case Report

https://doi.org/10.1016/j.transproceed.2015.04.083Get rights and content

Highlights

  • Meticulous screening during evaluation for heart transplant may miss occult cancer.

  • Low-grade malignancy in potential transplant candidates is a complex dilemma.

  • This is the first report of occult intracardiac malignancy after total artificial heart and successful bridge to transplant.

Abstract

Malignancy is the leading cause of long-term morbidity and mortality after heart and other solid organ transplantation; therefore, great emphasis is placed on pre- and post-transplantation cancer screening. Even with meticulous screening during evaluation for heart transplant candidacy, an occult cancer may not be apparent. Here, we share the case of a 51-year-old man with refractory heart failure who underwent total artificial heart implantation as a bridge to transplantation with the surprise finding of an isolated deposit of metastatic carcinoid tumor nested within a left ventricular papillary muscle in his explanted heart. The primary ileal carcinoid tumor was identified and resected completely. After remaining cancer-free for 14 months, he was listed for heart transplantation and was transplanted 2 months later. He is currently 3.5 months out from heart transplantation and doing well, without evidence of recurring malignancy.

Section snippets

Case Report

A 51-year-old man with dilated cardiomyopathy presented with left ventricular ejection fraction of 10–15%, left ventricular end-diastolic dimension of 8.6 cm, and continuous intravenous inotrope dependence. Right heart catheterization and echocardiography demonstrated biventricular failure without any findings suggestive of an intracardiac mass. He had recurrent episodes of symptomatic ventricular tachycardia and ventricular fibrillation, intolerance to inotropes and antiarrhythmics, and

Comment

For critically ill patients with refractory biventricular failure and/or arrhythmias, total artificial heart implantation improves survival to heart transplantation (79%) compared to no device (46%). TAH bridge to transplantation post-transplant survival at 1 and 5 years (86% and 64%) is similar to contemporary UNOS survival rates (84.7% and 69.8%) [2]. Survival 1 year after implantation is similar for TAH (59%) and continuous flow biventricular assist devices (BiVADs, 57%), with further

References (12)

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