ABSTRACT
TACROLIMUS, a mainstay of immunosuppression after orthotopic heart transplantation (OHT), is associated with a broad range of side effects. Vasoconstriction caused by tacrolimus has been proposed as a mechanism underlying common side effects such as hypertension and renal injury. Neurologic side effects attributed to tacrolimus include headaches, posterior reversible encephalopathy syndrome (PRES), or reversible cerebral vasospasm syndrome (RCVS). Six case reports have been published describing RCVS in the setting of tacrolimus administration after OHT. The authors report a case of perfusion-dependent focal neurologic deficits attributed to tacrolimus-induced RCVS in an OHT recipient.
Subject(s)
Heart Transplantation , Posterior Leukoencephalopathy Syndrome , Vasospasm, Intracranial , Humans , Tacrolimus/adverse effects , Vasospasm, Intracranial/chemically induced , Vasospasm, Intracranial/diagnostic imaging , Posterior Leukoencephalopathy Syndrome/chemically induced , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , Critical Illness , Perfusion/adverse effects , Heart Transplantation/adverse effectsSubject(s)
Dextrocardia/diagnostic imaging , Double Outlet Right Ventricle/diagnostic imaging , Situs Inversus/diagnostic imaging , Dextrocardia/surgery , Double Outlet Right Ventricle/surgery , Echocardiography, Transesophageal , Humans , Intraoperative Period , Male , Middle Aged , Models, Anatomic , Situs Inversus/surgeryABSTRACT
We present the case of a primigravid patient, who developed cardiogenic shock during the early postpartum period in the setting of retained placenta, uterine atony, and hemorrhage. Focused cardiac ultrasound played a central role in identifying the cause of hemodynamic instability. The decision to initiate venoarterial extracorporeal membrane oxygenation was instrumental in the successful outcome for our patient, characterized by a full recovery without major neurological and cardiovascular sequelae.
