Mycotic Aortic Aneurysm After Heart-Lung Transplantation

Marginal donors and organ shortness: concomitant surgical procedures during heart transplantation: a literature review

“…34 However, being that patient survival and freedom from ischemic events are comparable between younger and older donors at a mean follow-up of 5 years, the choice to implant a heart with preexisting coronary lesions is clinically supported giving the chance to expand the donor pool. 2,3 However, routine use of coronary angiography screening should be recommended, as two-or three-vessel coronary disease seems to be a serious risk for early graft failure and revascularization has to be considered. 4 The importance of coronary angiography lies in the fact that it can influence organ preservation and transport techniques.…”

Pseudoaneurysm of the ascending aorta: case report of a donor-derived Pseudomonas infection in a heart transplant recipient

“…4 ). Resected specimen of ascending aortic pseudoaneurysms of heart transplant patients frequently grows Staphylococcus aureus [ 4 – 17 ], P. aeruginosa [ 7 , 14 , 18 – 23 ] or Candida species, [ 7 , 14 , 21 , 24 – 29 ] but other gram-positive [ 7 , 14 , 30 , 31 ] or gram-negative [ 14 , 32 ] bacteria and Aspergillus fumigatus [ 33 – 35 ] are also reported as potential pathogens.

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“…The following predisposing factors for aortic wall infection and formation of mycotic pseudoaneurysm are documented in literature: intrathoracic infection (50%) [ 6 – 8 , 10 , 14 – 16 , 24 , 25 , 30 , 33 , 35 , 36 ], pneumonia or bronchitis (20%) [ 4 , 13 , 17 , 19 , 21 , 25 , 26 ], heart–lung transplantation (17.5%) [ 4 , 14 , 15 , 19 , 25 ], reoperation due to bleeding (15%), [ 4 , 8 , 13 , 31 ] diabetes mellitus (15%), [ 7 , 12 , 15 , 31 , 35 , 37 ] infection of a previous ventricular assist device (12.5%) [ 9 , 14 , 22 , 23 ], transmission of microorganisms from the donor (7.5%) [ 8 , 25 ], acute cholecystitis (5%) [ 28 , 33 ], urinary tract infection (5%) [ 18 , 31 ], other septicaemia (5%), [ 17 , 21 ] pacemaker endocarditis (2.5%), [ 13 ] skin disruption (2.5%), [ 29 ] heart–lung retransplantation (2.5%) [ 25 ].…”

“…Possible symptoms of mycotic aortic pseudoaneurysms are malaise [ 4 , 18 , 22 , 28 ], chest [ 6 , 8 , 10 , 12 , 28 , 32 ] or back pain [ 6 , 19 , 23 , 33 ], dyspnea [ 17 , 25 , 27 , 30 ], hoarseness [ 21 , 30 ] or fever [ 4 , 6 , 8 , 9 , 12 , 13 , 17 – 19 , 22 , 23 , 27 , 31 – 33 ]. However, completely asymptomatic cases are also reported [ 25 , 26 , 34 , 37 ].…”

“…Early diagnosis, surgical intervention and adjuvant antibiotic therapy seem to be the keys to successful management of mycotic pseudoaneurysms after HTX. Based on literature data of heart transplant patients with ascending aortic mycotic pseudoaneurysms with a median follow-up time of 8 months after diagnosis, almost two-thirds of patients recovered after operation [ 4 – 7 , 9 , 10 , 13 – 15 , 17 , 21 , 23 , 24 , 26 – 32 , 34 , 35 , 37 ], a sixth of them died due to pseudoaneurysm [ 4 , 6 , 8 , 14 , 16 , 25 , 33 ], and an eighth of them presented with a recurrent pseudoaneurysm later [ 7 , 8 , 12 , 19 – 21 ]. Median time between first surgical treatment for pseudoaneurysm and the verification of recurrence was 2 months.…”