Hernández-Caballero C, Martín-Bermúdez R, Revuelto-Rey J, Aguilar-Cabello M, Villar-Gallardo J
Intensive Care Unit of Virgen del Rocío University Hospital in Seville, Spain.
Transplant Proc. 2012 Sep;44(7):2106-10. doi: 10.1016/j.transproceed.2012.07.085.
We present the case of a 46-year-old woman referred to our center for urgent heart transplantation assessment, initially diagnosed as having cardiogenic shock of uncertain etiology. Some hours before she had suffered syncope without regaining consciousness. When she arrived at our hospital, the objective examination revealed bilateral unreactive mydriasis and absent brain-stem reflexes, and echocardiography showed global left ventricle wall hypokinesis sparing the apex. An urgent computed tomography (CT) imaging of the head was performed, which showed a massive subarachnoid hemorrhage and extensive cerebral edema. In the following hours, she fulfilled the criteria of brain-stem death and indeed became a multiorgan donor. The heart was rejected for transplantation because of the existence of left ventricle wall motion abnormalities associated with neurogenic stunned myocardium. Neurogenic stunned myocardium is a stress-related cardiomyopathy that occurs after an acute brain injury. It is especially frequent in subarachnoid hemorrhage, where it reaches an incidence of up to 40% of patients. It is characterized by acute electrocardiographic changes and regional hypokinesis of the left ventricle wall not consistent with the coronary artery distribution, and is thought to be a transient condition. For this reason it should not constitute an absolute contraindication to cardiac donation in young donors with no previous cardiac disease. In our hospital during the last year one third of the potential heart donors had regional left ventricle wall motion abnormalities compatible with neurogenic stunned myocardium. With the aim of improving the number of cardiac donors, several strategies have been described to try to demonstrate the reversibility of this entity, such as dobutamine stress echocardiography.
我们报告了一例46岁女性因紧急心脏移植评估被转诊至我院的病例，该患者最初被诊断为病因不明的心源性休克。数小时前她发生晕厥且未恢复意识。当她抵达我院时，体格检查发现双侧瞳孔散大固定且脑干反射消失，超声心动图显示左心室壁整体运动减弱，心尖部除外。紧急进行了头颅计算机断层扫描（CT）成像，结果显示大量蛛网膜下腔出血和广泛脑水肿。在接下来的几个小时里，她符合脑干死亡标准，实际上成为了一名多器官捐献者。由于存在与神经源性心肌顿抑相关的左心室壁运动异常，其心脏被拒绝用于移植。神经源性心肌顿抑是一种急性脑损伤后发生的应激相关性心肌病。在蛛网膜下腔出血中尤为常见，发生率高达40%的患者。其特征为急性心电图改变和与冠状动脉分布不一致的左心室壁节段性运动减弱，被认为是一种短暂性病症。因此，对于既往无心脏病的年轻捐献者，它不应构成心脏捐献的绝对禁忌证。在我院去年，三分之一的潜在心脏捐献者存在与神经源性心肌顿抑相符的左心室壁节段性运动异常。为了增加心脏捐献者数量，已描述了多种策略来试图证明这种情况的可逆性，如多巴酚丁胺负荷超声心动图检查。
