Christina Migliore

Scientific progress in heart and lung failure, mechanical circulatory support, and transplantation: Highlights from the Journal of Heart and Lung Transplantation

At the Thirty-third Annual Meeting and Scientific Sessions of the International Society of Heart and Lung Transplantation (Montréal, Quebec, Canada), a joint session between the Junior Faculty Council members and the editorial consultants of the Journal of Heart and Lung Transplantation took place to summarize recently published impacting publications in the Journal. The topics reviewed were mechanical circulatory support, heart transplantation, lung transplantation, pulmonary hypertension and pediatrics. The cooperative presentations has been formulated into the present report.

219: THE MASS THAT FAILED THE HEART!

www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives: Primary cardiac lymphomas are very rare, representing only 0.5% of all lymphomas. Pericardial tamponade is by far the most frequent manifestation. The presence of lymphoma within the heart has both local and systemic effects. This is the case report of a patient who presented with evidence of rightsided heart failure secondary to cardiac involvement of lymphoma Methods: 76 y/o woman with history of hypertension and chronic renal failure presented with worsening shortness of breath, pedal edema and fatigue. On physical examination, she was found to have pericardial friction rub, elevated jugular venous distension and laboratory work up revealed elevated brain natreuretic peptide and worsening renal function. Echo cardiogram revealed severe right ventricular dysfunction with a large mass in the right atrium with some extension into the right ventricle and moderate loculated pericardial effusion. Further work up revealed multiple mediastinal lymph nodes. Pericardial window did not yield much fluid and lymph node biopsy was non-diagnostic. Finally, excision of the mass was found to be B cell lymphoma. The patient presented with signs and symptoms of right heart failure secondary to an intra cavitary mass that was lymphoma. The patient underwent an incisional biopsy and debulking of the mass with diagnosis of diffuse large B cell lymphoma. The patient was treated with surgery and chemotherapy. A repeat TTE showed almost complete disappearance of the mass and improved right ventricular function. Results: Malignant lymphoma has cardiac involvement in 20–25% of patients. The pattern of cardiac involvement varies from nodular intracavitary growths causing outflow tract obstruction and infiltrative spread. The involvement of the right atrium and ventricle resulted in moderate right heart dysfunction which is often very difficult to manage. Debulking of the tumor and chemotherapy proved to be an effective treatment for his patient. This is a rare presentation of intracavitary lymphoma with right sided heart failure. So far in literature search, only a handful of cases have been reported