Poster 128: Ten-year-old girl with heart transplant: a case report.

Abstract

Setting: Free-standing rehabilitation hospital. Patient: A 10-year-old girl born with truncus arteriosis and who had undergone 4 prior surgeries for complex congenital cyanotic heart disease. Case Description: The patient experienced multiple complications during the fifth attempted surgical repair, resulting in ineffective cardiac output and requiring prolonged use of a bypass machine until a donor heart was obtained 7 days later. She had additional complications, including a yeast infection, delayed surgical closure of her chest due to the size of the donor heart, and required a tracheotomy after failing extubation. She was decannulated 1 month later and referred for comprehensive interdisciplinary rehabilitation as an outpatient. Functional limitations at that time included generalized weakness and fatigue, which interfered with ambulation and self-care, and dysphonia. She had lost 15lb. Physical examination showed cushingoid features, a hoarse soft voice, otherwise normal cranial nerves, well-healed surgical scars on her chest and neck, absent ankle stretch reflexes, grade 4/5 strength except at the ankles (where strength was grade 1), stronger on the left than the right, and a healing coccygeal pressure ulcer. Range of motion was functional. She demonstrated a steppage gait, which was improved with an off-the-shelf ankle-foot orthosis. Neurocognitive status was normal. She responded well to an interdisciplinary program including rehabilitation nursing, rehabilitation psychology, spiritual care, physical therapy, occupational therapy, and speech therapy and was able to return to school part time 3 months after her initial surgery. Assessment/Results: This youngster experienced many complications after her surgery, but enjoyed an excellent recovery and returned to nearly normal function with the assistance of a comprehensive interdisciplinary team. Discussion: Heart transplants are very rare in this age group and not without complications. Conclusion: Children with heart transplants can benefit from interdisciplinary rehabilitation.