Pulmonology & Lung Surgery

On admission, the patient’s PYP scan was highly positive, the most positive that Dr. Kadosh and team had ever seen, yet genetic testing and endomyocardical biopsy confirmed that the diagnosis was not cardiac amyloidosis.

A CT scan showed irreversible pulmonary hypertension, indicating that the patient could not undergo a heart and kidney transplant alone—he would not survive the surgery. Other tests revealed the kidney he received almost two decades earlier was rapidly failing.

The patient was admitted into the hospital, and had to wait two months for a suitable donor. A large team of doctors and nurses from the NYU Langone Transplant Institute conducted a 13-hour operation to successfully transplant the organs.

Surgical pathology from the cardiac explant revealed extensive microcalcification within the myocyte cytoplasm and cardiac interstitium involving the entire left ventricle and both atria. Further studies showed consistently elevated serum calcium and parathyroid hormone levels, suggesting the cause of his symptoms was tertiary hyperparathyroidism secondary to the failing kidney graft.

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