Korean Circ J.  2020 Jul;50(7):634-637. 10.4070/kcj.2020.0177.

Successful Heart Transplantation to a Fulminant Myocarditis Patient during COVID-19 Outbreak – Lessons Learned

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
  • 2Department of Pathology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
  • 3Department of Cardiothoracic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea


Figure

  • Figure 1 Anteroposterior chest radiography (A), electrocardiography (B) on first presentation. The chest radiography shows mild cardiomegaly with flattening of left cardiac border suggesting left atrial enlargement (A), and electrocardiography shows sinus rhythm with a nonspecific intraventricular conduction delay and ST-segment elevation in precordial leads (B).

  • Figure 2 Anteroposterior chest radiography (A), electrocardiography (B) on post-admission day 5. The chest radiography and computed tomography shows slightly decreased cardiac size with increased both lung congestion after the extracorporeal membrane oxygenator apply (A), and electrocardiography shows a few faint ventricular escape rhythm with non-conducted baseline p waves (B).

  • Figure 3 Gross specimen and microscopic findings of the explanted heart. Gross specimen shows enlarged ventricular chambers (A), and H&E stain shows lymphocyte dominant with plasma cell and eosinophil infiltration (lymphocyte – yellow arrow, plasma cell – red arrow, eosinophil – yellow arrowhead) and diffuse myocyte damage (red arrowhead) compatible with fulminant myocarditis by Dallas criteria (B).

  • Figure 4 Algorithm of the SARS-CoV-2 Test Strategy for the brain death donor and candidate for heart transplantation during COVID-19 outbreak. Brain death donors should be tested for SARS-CoV-2 infection (preferably rRT-PCR assay from upper and/or lower respiratory tract specimens). If the test result is negative, organ donation can be safely proceeded. When the heart transplantation recipient has symptoms suggesting viral infection, unknown cause of fever, or close contact history with the SARS-CoV-2 infected patients prior 14 days, test for SARS-CoV-2 infection should be performed and proceed heart transplantation when the result is negative. Members of the donor management team and the organ procurement team should apply adequate personal protective equipment. Confirmation of the negative SARS-CoV-2 result need to be ensured according to the strategy of each hospital organ procurement organization. If the symptom of SARS-CoV-2 infection is highly suggested, repeated test need to be performed for the suspicious result.SARS-CoV-2 = severe acute respiratory syndrome coronavirus-2; COVID-19 = coronavirus disease 2019; rRT-PCR = real-time reverse transcription polymerase chain reaction; PPE = personal protective equipment.


Cited by  3 articles

Updates of Cardiovascular Manifestations in COVID-19: Korean Experience to Broaden Worldwide Perspectives
In-Cheol Kim, Hyun Ah Kim, Jae Seok Park, Chang-Wook Nam
Korean Circ J. 2020;50(7):543-554.    doi: 10.4070/kcj.2020.0205.

Heart Transplantation to Fulminant Myocarditis during COVID-19 Outbreak
Viroj Wiwanitkit
Korean Circ J. 2020;50(11):1040-1040.    doi: 10.4070/kcj.2020.0357.

Author's Reply to Heart Transplantation to Fulminant Myocarditis during COVID-19 Outbreak
In-Cheol Kim, Ilseon Hwang, Yun Seok Kim, Jae-Bum Kim
Korean Circ J. 2020;50(11):1041-1042.    doi: 10.4070/kcj.2020.3571.


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