Significant practice-changing developments have occurred in the care of heart transplantation candidates and recipients over the past decade. This Canadian Cardiovascular Society/Canadian Cardiac Transplant Network Position Statement provides evidence-based, expert panel recommendations with values and preferences, and practical tips on: (1) patient selection criteria; (2) selected patient populations; and (3) post transplantation surveillance. The recom-R ESUM E Les pratiques relatives aux soins prodigu es aux candidats à une transplantation cardiaque et aux receveurs d'un nouveau coeur ont beaucoup evolu e depuis dix ans. Le pr esent enonc e de position conjoint de la Soci et e canadienne de cardiologie et du Canadian Cardiac Transplant Network fait etat des recommandations d'un groupe d'experts fond ees sur des donn ees probantes, et comprend des valeurs et des pr ef erences ainsi que des conseils pratiques concernant

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Background Fulminant viral myocarditis (FVM) is a rare cause of cardiogenic shock associated with high morbidity and mortality rates. An inappropriately activated immune system results in severe myocardial inflammation. Acute immunosuppressive therapy for FVM therefore gained in popularity and was described in numerous retrospective studies. Methods We conducted an extensive review of the literature and compared it with our single-centre retrospective review of all cases of FVM from 2009-2019 to evaluate the possible effect of acute immunosuppression with intravenous immunoglobulins and/or high dose corticosteroids in patients with FVM. Results We report on 17 patients with a mean age of 46 ± 15 years with a mean left ventricular ejection fraction (LVEF) of 15 ± 9% at admission. Fourteen (82%) of our patients had acute LVEF recovery to ≥ 45% after a mean time from immunosuppression of 74 ± 49 hours (3.1 days). Extracorporeal membrane oxygenation (ECMO) was required in 35% (6/17) of our patients for an average support of 126 ± 37 hours. Overall mortality was 12% (2/17). No patient needed a long-term left ventricular assist device or heart transplant. All surviving patients achieved complete long-term LVEF recovery. Conclusions Our cohort of 17 severely ill patients received acute immunosuppressive therapy and showed a rapid LVEF recovery, short duration of ECMO support, and low mortality rate. Our suggested scheme of investigation and treatment is presented. These results bring more cases of successfully treated FVM with immunosuppression and ECMO to the literature, which might stimulate further prospective trials or a registry.

A 60-year-old man with a seven-year history of coronary artery disease was admitted for suspected unstable angina. He was well until two weeks previously, when he experienced several episodes of squeezing chest pain while at rest, lasting 5 min to 15 min, accompanied by dyspnea and sweating. Episodes were relieved by sublingual nitroglycerine. In the previous month, the patient had also noted progressive dyspnea on light exertion and new-onset nocturnal dyspnea, with recent episodes of flushing and diarrhea. He had unaccountably lost 22.7 kg in the preceding four months. Night sweats and fever were absent. Recently, furosemide 40 mg had been added to control new-onset lower limb edema. Other daily medications were acetylsalicylic acid 81 mg, valsartan 80 mg and lovastatin 20 mg.In the emergency room, the physical examination showed a mildly obese man without distress. Central venous pressure was elevated with V waves. A grade II/VI holosystolic regurgitant murmur was heard at the left and right sternal borders. Lung auscultation was normal, and a 2 cm pitting edema was noted at the ankles with stasis dermatitis. The electrocardiogram (ECG) was normal and cardiac troponin was negative. The patient was admitted with a diagnosis of acute coronary syndrome. The patient was started on heparin, nitrates and a betablocker. Echocardiography showed normal left ventricular systolic function with grade 2 mitral and grade 3 tricuspid regurgitation. The sonographer also reported abnormal hepatic lesions compatible with liver metastases.During his hospital stay, the patient presented with several episodes of chest pain at rest. The ECG showed a junctional rhythm with ST segment elevation in the inferior leads (II, III and aVF) and ST segment depression in the other leads ( Figure 1). Coronary angiography showed diffuse disease with 70% stenosis in the mid segment of the left anterior descending coronary artery and a 50% stenosis on the second diagonal CASE REPORT ©2006 Pulsus Group Inc. All rights reserved C Bourgault, S Bergeron, P Bogaty, P Poirier. A most unusual acute coronary syndrome. Can J Cardiol 2006;22(5):429-432.A 60-year-old man, known for stable coronary artery disease, was admitted for suspected unstable angina. In the previous month, the patient presented with progressive dyspnea on light exertion. In the preceding four months, he had experience occasional episodes of flushing and diarrhea, and had inexplicably lost 22.7 kg. Night sweats and fever were absent. ST segment elevation in the inferior leads and ST segment depression in the precordial leads were documented during an episode of chest pain. The coronary angiogram showed diffuse disease with 70% stenosis of the left anterior descending coronary artery and 50% stenosis on the second diagonal (D 2 ). An echocardiogram showed a patent foramen ovale. Balloon angioplasty and stenting were performed on the two lesions. Two days later, prolonged chest pain recurred. Cardiac catheterization was repeated and showed occlusive thrombus within the stent on the D 2 ...