%0 Journal Article
%T Wait, treat and see: echocardiographic monitoring of brain-dead potential donors with stunned heart
%A Marilena Casartelli
%A Tonino Bombardini
%A Davide Simion
%A Maria Gaspari
%A Francesco Procaccio
%J Cardiovascular Ultrasound
%D 2012
%I BioMed Central
%R 10.1186/1476-7120-10-25
%X To assess the recovery of left ventricular dysfunction in potential brain-dead donors with hemodynamic instability treated by aggressive treatment and HT.In a single-center, observational study design, we evaluated 15 consecutive brain-dead potential donors (DBD) (8 males, age£¿=£¿48£¿¡À£¿15£¿years) with hemodynamic instability. All underwent standard hemodynamic monitoring and transthoracic 2-dimensional echo (2-DE) with assessment of Ejection Fraction (EF). Measurements were obtained before BD and after BD within 6£¿h, at 24£¿h and within 48£¿h. HT (with insulin, methylprednisolone, vasopressin and T3) was started as soon as possible to treat hemodynamic instability and avoid administration of norepinephrine (NE). Eligible potential heart donors underwent coronary angiography.After HT, we observed a normalization of hemodynamic conditions with improvement of mean arterial pressure (pre£¿=£¿68£¿¡À£¿8£¿mmHg vs post£¿=£¿83£¿¡À£¿13£¿mmHg, p£¿<£¿.01), cardiac index (pre£¿=£¿2.4£¿¡À£¿0.6£¿L/min/m2 vs post 3.7£¿¡À£¿1.2£¿L/min/m2, p£¿<£¿.05), EF (pre£¿=£¿48£¿¡À£¿15 vs post£¿=£¿59£¿¡À£¿3%, p£¿<£¿.01) without administration of norepinephrine (NE) in 67% of cases. Five potential donors were excluded from donation (opposition, n£¿=£¿3, tubercolosis n£¿=£¿1, malignancy n£¿=£¿1). At pre-harvesting angiography, coronary artery stenosis was present in 2 of the 10 consented donors. Eight hearts were uneventfully transplanted. No early graft failure occurred and all eight recipients were alive at 6-month follow-up.In BD donors, intensive treatment including HT is associated with improvement of regional and global LV function and reverse remodeling detectable by transthoracic 2DE. Donor hearts with recovered LV function may be eligible for uneventful heart transplant. The wait (in brain death), treat (with HT) and see (with 2D echo) strategy can help rescue organs suitable for heart donation.Heart transplantation is an established procedure in end-stage heart failure patients, with satisfying long-term results. However, this surgical
%K Brain death
%K Cardiac allograft acceptance
%K Echocardiography assessment
%K Heart transplantation
%K Hormonal treatment
%K Neurogenic stunning
%K Takotsubo cardiomyopathy
%U http://www.cardiovascularultrasound.com/content/10/1/25