Title : Luxatio Cordis, A heart transplant complications
Cardiac luxation is a rare, difficult-to-diagnose, dramatic complication. It has only been reported until now as a consequence of blunt chest trauma causing pericardial rupture. These cases may require prompt surgical intervention to reposition the heart and restore hemodynamic stability. However, to our knowledge, here we present the first case of luxatio cordis that was found incidentally in a 54-year-old woman s/p Orthotopic Heart Transplant (OHT) procedure. The patient’s past medical history was significant for chronic kidney disease, scleroderma, rheumatoid arthritis, interstitial lung disease, and nonischemic cardiomyopathy with reduced ejection fraction, for which she underwent a heart transplant two years ago. Before admission, the patient presented to the outpatient clinic with gradually progressive dyspnea on minimal exertion, paroxysmal nocturnal dyspnea (PND), peripheral edema, and abdominal distention, which improved only transiently with oral diuretic regimen. She was diagnosed with acute pulmonary edema and her symptoms improved after IV Lasix was administered. A CT scan was obtained to confirm her diagnosis which incidentally revealed that the heart was herniated through the ribs. Since the patient had a benign clinical course, we recommended follow up with cardiothoracic surgery as an outpatient.
What will audience learn from your presentation?
- The prognosis of patients with luxatio cordis has not been recorded but recognizing this diagnosis is important in order to provide immediate treatment since the condition can deteriorate quickly especially in the setting of a blunt trauma that could lead to a potentially fatal outcome.
- Nonetheless, it should be noted that heart luxation can also be asymptomatic and present as an incidental radiographic finding status post heart surgery.
- If the patient is hemodynamically unstable, surgical intervention is necessary whereby the heart could be repositioned and the pericardium could be reconstructed.
- However, if the patient is stable, a careful watch-and-see approach is justified. Careful echocardiogram follow up in patients with this condition is necessary to prevent hemodynamic impairment.