A Case of Heart Transplantation after Ischaemic Preconditioning

A case of successful heart transplantation from a donor that suffered an out of hospital cardiac arrest lasting approximately one hour is presented. The recipient, a 27-year-old female nurse, was diagnosed with arrhythmogenic right ventricular cardiomyopathy in 2012. The donor was a 24-year-old male who after consuming an unknown quantity of alcohol and cocaine aboard a yacht was found floating face-down in the sea. The patient to be pulseless and CPR commenced after 7 minutes. The length of time that he spent in the sea was unknown. Return of spontaneous circulation (ROSC) occurred after 20 minutes of CPR on site. However, the patient arrested again in the ambulance and CPR was performed until he arrived Hospital, still in cardiac arrest. The patient arrested three more times before achieving a stable circulation. He was transferred to the intensive care unit on high doses of Noradrenaline and Adrenaline to maintain an adequate mean arterial blood pressure. An initial echocardiogram (ECHO) revealed a hypocontractile left ventricle (LV) with an estimated ejection fraction (EF) of 30%.Over the following 3 days the patient’s cardiac function improved. He was  weaned off inotropic support and a repeat ECHO showed a normal LV with an EF of 70%. A brain MRI showed diffuse swelling consistent with global hypoxic injury with wide areas of cortical and basal ganglia infarction. The patient’s parents gave their consent and he was offered for organ transplantation on day 6. The operation was successful, with the recipient making an uneventful recovery. She received immunosuppressive treatment with cyclosporine, prednisolone and azathioprine and experienced one episode of early mild rejection with full resolution. She remains well 8 months later.