Technique and Results of Cardiac Transplantation Using "Domino-Donor" Hearts

Heart-lung transplantation is now well established for treatment of patients with terminal cardiopulmonary disease. More than 50% of heart-lung transplant recipients have normal or near normal hearts, with the majority having some degree of right ventricular hypertrophy. This potential source of "prepared" cardiac allografts remained untapped until the introduction of the "domino-donor" operation, a procedure in which the heart-lung recipient serves as a cardiac donor. The implantation of these available allografts contributes to the alleviation of the short supply of donor organs for cardiac transplantation. Aspects of the surgical technique, results, and potential benefits of this procedure are presented.     

Pacemaker Upgrade for Recurrent Pacemaker Syndrome Using a Redundant Contralateral Electrode in a Patient with Bilateral Venous Stenoses

Following His-bundle ablation and VVIR pacemaker implantation, severe Pacemaker syndrome developed and was treated with DDDR pacing in a 70-year-old woman. Due to bilateral subclavian vein stenosis, DDDR pacing could not be maintained and an unusual method of restoring atrioventricular synchrony is described using the contralateral redundant atrial electrode connected to the ipsilateral dual chamber pacemaker and ventricular electrode.     

Buschke-Ollendorff syndrome (disseminated dermatofibrosis with osteopoikilosis)

The case is reported of a woman aged 47 years with dissemiated dermatofibrosis associated with osteopoikilosis. Her two children also showed skin lesions typical of the Buschke-Ollendorff syndrome and these lesions were said to have been present at birth.     

Inappropriate Discharges by the Implantable Cardioverter Defibrillator During Postoperative Testing: Implications for Intraoperative Assessment

Inappropriate shocks were delivered to a patient while in sinus rhythm by an implantable cardioverter defibrillator (ICD) during routine prehospital discharge testing. This was induced by the standard programmer when the "read" telemetry sequence was initiated. The ICD was removed and found to suffer from electrical artifact that was sensed as ventricular tachycardia during telemetry. To avoid inadvertent telemetry-induced shocks during routine testing, all ICDs should be interrogated, using a standard programmer, intraoperatively, with the unit in "defibrillation on" mode.     

Twister

A 75-year-old male presented with an extensive anterior myocardial infarction. He underwent primary coronary angioplasty to the proximal left anterior coronary artery, which was successful and uncomplicated. Several days later he sustained a cardiac arrest and was successfully resuscitated. An electrophysiological study revealed inducible ventricular tachycardia. An automatic implantable cardioverter defibrillator (ICD) was placed in a subcutaneous abdominal position. After the device was implanted, the patient developed pneumonia and a hematoma in the generator pocket.