Triple ECMO therapy and emergency PCI performed perioperatively during pediatric heart transplantation

Abstract

8 years boy, a case of dilated cardiomyopathy with severe biventricular dysfunction awaiting heart transplantation, sustained cardiac arrest. He was initiated on central ECMO, stabilised and then heart transplantation was performed. In the immediate post-transplant period he hemodynamically worsened; peripheral VA ECMO was inititated and he was stabilised. Later he developed cardiac arrest again with ST changes, dilated RV and free TR. Graft rejection was suspected and treatment initiated. Coronary angiography revealed significant CAD and ad hoc PTCA of RCA and LAD was performed. Patient hemodynamically deteriorated due to acute stent thrombosis of RCA after PTCA. RCA was revascularized; peripheral VA ECMO was established again and patient was successfully revived.

Keywords

• Heart transplantation
• Donor transmitted coronary artery disease
• ECMO
• Emergency PCI
• Pediatric heart transplant
• Emergency coronary stenting