Combined Heart-Liver Transplant in a Patient With End-Stage Liver Disease and Contained Rupture of an Aortic Root Pseudoaneurysm

A patient with end-stage liver disease, aortic stenosis, and rapid progression of an aortic root pseudoaneurysm underwent successful combined heart-liver transplantation. This patient was a 56-year-old woman with decompensated cirrhosis, severe aortic stenosis, and an aortic root pseudoaneurysm with streptococcal bacteremia and aortic valve endocarditis. The pseudoaneurysm rapidly progressed, with evidence of contained rupture. Given the operative risk posed by liver disease, the patient was evaluated and ultimately underwent heart-liver transplantation. This case highlights the novel use of combined heart-liver transplantation and demonstrates the safety of applying this therapy in patients with a prohibitive risk for conventional cardiac surgery.