Nicoletta Barzaghi

ECMO and Inhaled Nitric Oxide for Cardiopulmonary Failure After Heart Retransplantation

Cardiopulmonary failure occurred in a 62-year-old patient a few hours after emergency cardiac retransplantation. Venoarterial extracorporeal membrane oxygenation was required to support biventricular dysfunction; thereafter, inhaled nitric oxide was given for residual hypoxemia and pulmonary hypertension. We report survival after venoarterial extracorporeal membrane oxygenation and inhaled nitric oxide treatment for both heart and lung failure in a heart recipient.

An unexpected intraoperative echocardiographic finding in a patient with Eisenmenger's syndrome

A 46-YEAR-OLD woman with end-stage Eisenmengers syndrome secondary to an atrial septal defect was referred to the Division of Cardiothoracic Surgery for singlelung transplantation and closure of the atrial septal defect. Her previous history was positive for varicose veins of the fight leg surgically treated in 1990 and a stroke in December 1995. On the latter occasion, an asymptomatic atrial septal defect was diagnosed. In March 1996, the patient reported fatigue and dyspnea. At right cardiac catheterization, severe pulmonary vascular hypertension was shown. The patients history and hemodynamics were considered highly significant for Eisenmengers syndrome. Because of the cardiac defect and consequent possibility of paradoxical embolism after injection of labeled albumin microspheres, the medical staff decided not to perform the perfusion lung scan in this patient, who was then included on the transplant list without further investigations. While waiting for transplantation, her clinical condition markedly worsened, and on admission she received continuous oxygen therapy at 4 L/rain. A transesophageal echocardiographic examination performed during surgery showed the following images of the main pulmonary artery and its branches (Figs 1 and 2). How would you interpret these echocardiographic findings? Would you change the scheduled operation on the basis of these data?