Inferior vena cava stenosis after heart transplant: a rare cause of venoarterial extracorporeal membrane oxygenation weaning failure

Abstract

Introduction:

The discontinuation of venoarterial extracorporeal membrane oxygenation (VA ECMO) is a critical step in patient recovery. To reduce risks, weaning trials must be performed to buttress this important decision. However, a successful weaning trial does not preclude the possibility of complications.

Case report:

Here, we report a case of sudden multiple organ failure in a heart transplant patient, occurring after a successful ECMO weaning trial. We finally diagnosed a rare post-surgical complication of bicaval orthotopic heart transplantation, a severe stenosis of the inferior vena cava (IVC) that had been masked by the post-operative ECMO.

Discussion and conclusion:

Our case report should serve as a cautionary tale: it may be of interest to add a search for complications at the vascular anastomoses to the weaning trial procedure and to keep an eye out for them in the following days.

Keywords

cardiac transplantation extracorporeal membrane oxygenation weaning cardiac surgery multiple organ failure primary graft dysfunction inferior vena cava stenosis

Get full access to this article

View all access options for this article.

References

Aissaoui

Luyt

Leprince

et al . Predictors of successful extracorporeal membrane oxygenation (ECMO) weaning after assistance for refractory cardiogenic shock. Intensive Care Med 2011; 37: 1738–1745.

Schnoor

Schäfer

Lühmann

et al . Bicaval versus standard technique in orthotopic heart transplantation: a systematic review and meta-analysis. J Thorac Cardiovasc Surg 2007; 134: 1322–1331.

Kobashigawan

Zuckermann

Macdonald

et al . Report from a consensus conference on primary graft dysfunction after cardiac transplantation. J Heart Lung Transplant 2014; 33: 327–340.

D’Alessandro

Aubert

Golmard

et al . Extracorporeal membrane oxygenation temporary support for early graft failure after cardiac transplantation. Eur J Cardiothorac Surg 2010; 37: 343–349.

Tack

Wellens

Goethals

et al . Stenosis of caval connections in orthotopic heart transplantation: an underestimated complication? J Heart Lung Transplant 2002; 21: 100.

Jacobsohn

Avidan

Hantler

et al . Case report: inferior vena-cava right atrial anastomotic stenosis after bicaval orthotopic heart transplantation. Can J Anesth 2006; 53: 1039–1043.