Atrial Septal Defect Revealed by Repeat Echocardiography in a Brain-Dead Donor: A Case Report.

BACKGROUND

The number of patients undergoing heart transplantation is limited because of the shortage of donor hearts. Expanding the donor pool with precise evaluation of donor heart is the most practical way to increase the number of patients undergoing heart transplantation. However, echocardiographic evaluation of especially right ventricle (RV) in brain-dead donors is challenging. Repeated echocardiography with volume overload may reveal unrecognized congenital heart disease such as atrial septal defect (ASD).

MATERIALS AND

METHODS

A case of repeated echocardiography revealed ASD secundum in a donor with significant RV enlargement and dysfunction from previously unknown origin. An almost-discarded donor heart was used in heart transplantation after simple patch closure.

RESULTS

The patient was discharged after a month. One year later, he has been doing well without significant adverse events.

CONCLUSIONS

RV dysfunction prior to heart transplantation increases the risk of post-transplant graft failure. Secundum-type ASD and ventricular septal defect, which are relatively common adult congenital heart diseases that cause RV enlargement and dysfunction, are not contraindications for heart transplantation. Our case showed that repeat echocardiography revealed congenital heart disease and rescued the almost-discarded heart. This simple maneuver is essential in donor heart evaluation to maximize the utility of marginal donors.