In summary, perioperative measurement of cTnI, CK and PCT reflects myocardial damage and systemic inflammatory response and allows an improved peri- and postoperative management. PiCCO technique is an excellent, less invasive tool to determine postoperative cardiac function.
Bedside fetal magnetocardiography revealed the exact diagnosis of the long QT syndrome in a period of the gestation when the fetus was electrically isolated by the vernix caseosa that hinders electrocardiography. To patients at risk of fetal cardiac abnormalities, magnetocardiography can be offered as a non-invasive diagnostic bedside procedure. The diagnosis should trigger closer surveillance and delivery in a perinatal center.
In the first two yr of life blood-group incompatible (ABO-incompatible) heart transplantation can be performed leading to immune tolerance to donor blood group. Antibody titers should be below 1:4. VAD use is correlated with sensitization toward blood-group antigens. A boy was diagnosed with dilated cardiomyopathy at nine months of age and listed for 0-compatible transplantation. Progressive heart failure required implantation of a left VAD. His listing was extended for ABO-incompatible transplantation despite antibody titers of 1:32 anti-A and 1:8 anti-B. After 26 days on VAD, he was transplanted with a B donor heart. No hyperacute or acute rejection occurred in 12 months post-transplant. Anti-B antibodies rose to a maximum of 1:2. No use of rituximab or plasmapheresis was required. There are no signs of graft vasculopathy. This indicates that inclusion criteria for ABO-incompatible transplantation may be extended to immediate cases. This is the first case with a healthy immune system to show signs of tolerance development after ABO-incompatible heart transplantation with increased prior antibody titers and without specific treatment.
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