The success of the first case of heart transplant for a paraganglioma and how to identify it

Specialist recounts his experience as part of a heart transplant team, as a result of a malignant tumor in a young Puerto Rican.

Dr. Gisela Puig Carrión, specialist in Advanced Heart Failure and Heart Transplantation, part of the Heart Transplantation team, at the Cardiovascular Hospital of Puerto Rico. Photo: Medicine and Public Health Magazine.

Dr. Gisela Puig Carrión, who is a specialist in Advanced Heart Failure and Transplant of Heart, and be part of the team of Transplant Heart, Hospital Cardiovascular from Puerto Rico; narrates to the magazine of Medicine and Public Health, in an exclusive interview, how was the experience in front of the first case of Transplant of the Heart due to a malignant tumor in a young 19-year-old Puerto Rican athlete.

How was the care process?

Who was in good health, and who, in the middle of a game, “begins to feel palpitations and shortness of breath, decides to go to the emergency room where they found supraventricular tachycardia, and they transferred him to the Pediatric Hospital Medical Center, in where they give him amiodarone medication, the tachycardia resolves, however, it is necessary to investigate why that tachycardia went up first?”, confirms Dr. Gisela Puig Carrión, specialist in Advanced Heart Failure and Transplant de Corazón, part of the team of Transplant Heart, Hospital Cardiovascular from Puerto Rico.

It is then that different studies are carried out to determine the diagnosis, cardiac emaray, chest CT, echocardiogram are performed and, “it turns out that the young man has a large mass in the left atrium”, that is when he is transferred to the Hospital Cardiovascular from Puerto Rico, but I’m sorry for the highly vascular mass, which is why “I bled a lot when trying to make the reception, since there was a lot of extension of the mass”, and for which it was decided to take a biopsy of the mass to determine the case .

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What was the result of the biopsy?

The result was a paraganglioma malignant, paragangliomas are abnormal neoplasms of cells that are formed from a specific type of nerve cells that are distributed throughout the body, these chromaffin cells, play important roles in the body, for example in the regulation of blood pressure.

In this case the tumor was present in the heart, “not all are benign or malignant, this is a neuroendocrine tumor, and it secretes different substances in the body causing different symptoms, in the case of our patient, he faces a paraganglioma but he was not secreting ‘norepinephrine’ so he was not presenting any symptoms, tachycardia, lack of pressure control, among other things”, confirms the specialist.

This type of malignant tumor, for which it is necessary to be able to carry out an entire imaging study, in order to determine if there are metastases in any part of the body, for which “a T-scam was done, a CT scan, we already had the emaray confirmed the mass, so it was verified that there were no metastases and the oncology team was consulted, and since it was a malignant and aggressive tumor, they confirmed that palliative chemotherapy could be given; at that time the pediatric team , were very diligent in making a query to the team of transplantbecause the healing of these cases is the complete reception of the mass”, shares Dr. Carrión.

What symptoms can this type of tumors provide?

In general, signs and symptoms of a neuroendocrine tumor may include the following:

  • Pain from a growing tumor

  • A growing lump that can be felt under the skin

  • feeling unusually tired

  • weight loss without trying

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Neuroendocrine tumors that produce excess hormones (functional tumors) could cause the following:

Evaluation of the case and why is it the first case as such?

“The curious thing about this case is that there was no evidence in the medical literature of patients who had been transplanted with a paraganglioma so we proceed to evaluate the patient”, confirms Dr. Carrión, who maintains that the next step was to contact the Organ Donation Association, to find out how to accommodate this patient on the list and in which states he entered.

This, taking into account that the medicine of transplant“malignancy is a contraindication for transplantation, but in the case of this patient, the malignancy is only on the left side,” says the specialist.

The patient was listed in status #1, that is, with higher priority, the scale goes from 1 to 6 and six corresponds to patients who can live with their condition, from home, but who are still in the process of waiting for a donor

“For us it was very gratifying and extremely important to be able to cooperate in a case like this, because it is something different, a child whose only cure was being able to transplant him, we are pioneers in this type of transplantbecause a similar case had not been seen and we have the experience of this situation”, shares Dr. Gisela Carrión.

See the full program here.

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