Ann Thorac Surg 2003;75:598
© 2003 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Ventricular fibrillation in a heterotopic heart transplant recipient
D. Michael McMullan, MDa,
Susan Wilansky, MDa,
O.H. Frazier, MDa*
a Division of Cardiopulmonary Transplantation, St. Luke’s Episcopal Hospital, Texas Heart Institute, Houston, Texas, USA
* Address reprint requests to Dr Frazier, Division of Cardiopulmonary Transplantation, Texas Heart Institute, PO Box 20345, Houston, TX 77225-0345, USA.
e-mail: knowlin{at}heart.thi.tmc.edu
A 50-year-old man presented to the emergency room with diffuse chest pain and mild dyspnea. He had undergone a heterotopic heart transplant 10 years earlier. Ventricular fibrillation of the patient’s native heart was detected by electrocardiograms of the left (Fig 1A)
and right chest (Fig 1B) and confirmed by echocardiography (Fig 2).
Figure 1A demonstrated ventricular fibrillation in leads V2 to V6 and normal sinus rhythm in leads I, II, III, aVR, and aVF. Lead V1 showed a predominant pattern of sinus rhythm superimposed on a background of ventricular fibrillation. Figure 1B demonstrated a predominant pattern of ventricular fibrillation in lead V1. A continuous transthoracic echocardiogram of the native heart during two cardiac cycles of the donor heart (Fig 2 [LA = left atrium; LV = left ventricle; MV = mitral valve]) showed loss of ventricular contraction and mitral valve opening. After electrocardioversion, the patient’s heart rhythm returned to normal, and his symptoms disappeared. He remains well.
