SATS 2009 Final Program - Scandinavian Association for Thoracic ...

P01:30
TWO PATIENTS WITH VENTRASSIST SUCCESSFULLY TREATED FOR CANDIDAS ALBICANS.
Gude Einar 1 , Bjornholt Jorgen 1 , Andreassen Arne K 1 , Sorensen Gro 1 , Geiran Odd R 1 , Fiane Arnt E 1
1) Oslo University Hospital, Rikshospitalet, Norway
Infections are a major cause of morbidity and mortality in patients with LVAD.
Secondary to antibiotic use, invasive fungal infections are a feared and well known complication.
We present the history of two Ventrassist patients with invasive candida albicans that were successfully eradicated.
Patient 1. 17 year old female with Ventrassist due to acute myocarditis. Because of myocardial recovery explant of
Ventrassist was planned. After an episode of gastroenteritis complicated by paralytic ileus, Enterobacter cloacae was
detected on a central venous line catheter. After 10 days of treatment with meropenem, Candida albigans was found
in 3 consecutive blood cultures. She was successfully treated with caspofunginacetat for 3 weeks. No recurrence of
fungal infection was found in serial blood culture or on explanted LVAD. LVAD successfully explanted.
Patient 2. 52 year old female with Ventrassit due to heart failure. After initial improvement she experienced a
cerebral hemorrage, surgically evacuated complicated by long term respirator use. After treatment with meropenem
and linezolid for 12 days for Staphylococcus aureus and Enterococcus, Candida albicans was detected in blood
culture. After treatment with caspofunginacetat for 3 weeks, fungal infection was no longer detectable in serial
blood cultures. Follow up 3 months. Listed for heart transplantation.
Conclusion
Invasive Candida albicans has occured in two of our Ventassist patients secondary to antibiotic use. Both patients
were successfully eradicated without evidense of recurrence. This is in contrast to our previous experience of fungal
infections were foreign material must be replaced or removed before eradication of infection is possible.
P01:31
STRESS INDUCED CARDIOMYOPATHY, TAKOTSUBO SYNDROME, COMPLICATING EARLY
RECOVERY AFTER LUNG TRANSPLANTATION
Hämmäinen Pekka 1 , Virolainen Juha 1 , Eriksson Heidi 1 , Lemström Karl 1 , Piilonen Anneli 1 , Harjula Ari 1 , Sipponen Jorma 1
1) Helsinki University Hospital, Finland
Primary graft dysfunction, infection, and acute rejection are major concerns complicating early recovery after lung
transplantation. We present a case report, in which stress induced cardiomyopathy mimicked severe delayed primary
lung graft failure.
A 56-year-old woman with emphysema was referred for lung transplantation. Among other examinations, her
cardiac ECHO showed normal right and left ventricle function, with tricuspid gradient of 31 mmHg, and LV EF
61%. Her coronary angiogram was normal. As suitable donor lungs became available, her CRP was 231 and she
had recurrent pneumonia. The procedure itself was uneventful, and she was extubated 7 hours later. Native lungs
contained macroscopically seen foci of aspergillosis. On 17th postoperative day, she unexpectedly presented twice
grand mal type seizures on ward, after which she was intubated. Next morning chest-xray showed new congestive
features, and pleural effusions were drained. Oxygenation further deteriorated and CT showed extensive alveolar
infiltrates. Infection as well as acute rejection were initially considered possible. However, pro-BNP value, not
determined earlier, was high 12300 ng/l. Cardiac echo showed normal right heart, but left ventricular anteroapical
and posterior walls were largely akinetic, and planimetric estimate of ejection fraction was only 25-30% . The
overall findings were compatible with Takotsubo syndrome. LV function was supported pharmacologically, and the
outcome was excellent.
Takotsubo syndrome has not earlier been described to complicate lung transplantation. Newly transplanted lungs
are highly vulnerable to elevated left atrial filling pressure. Correct diagnosis and avoiding additional antirejection
treatment most probably contributed to eradication of aspergillus.
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