[Complications in heart transplantation: diagnosis and treatment]. / Les complications en transplantation cardiaque: diagnostic et traitement.

ACUTE REJECTION: Endomyocardial biopsy is the most reliable method to detect acute rejection but is an invasive procedure. Other non-invasive methods have been proposed including tissular Doppler ultrasonography with analysis of the posterior wall velocity and teletransmitted study of the intramyocardial amplitude of the QRS complex. Adding plasmapheresis to the conventional treatment is helpful in improving survival and reducing the incidence of late coronary disease after severe acute reflection. Plasmapheresis also has a preventive effect as do certain inductors such as anti-thrombocyte globulin (ATG). INFECTION: Opportunistic infections are the leading cause of mortality in the year following heart transplantation, generally related to the hypogammaglobulinemia. Intravenous immunoglobulins have helped reduce the frequency of infections. CANCER: More than 1/3 of donor cancers diagnosed after transplantation will be transmitted to the cardiothoracic organ recipient. Melanoma, choriocarcinoma and renal carcinoma with vascular effraction are the most transferable tumors. DIABETES: Survival at 5 years is lower in heart transplant recipients but at 10 years the incidence of coronary artery disease and infection are the same. However at 10 years, creatininemia is higher as is the frequency of lower limb arteropathies. RHABDOMYOLYSIS: The incidence of rhabdomyolysis after heart transplantation in patients treated with statin is much higher than in the general population, but complementary studies are needed to compare the muscular effects of the different statins in transplant recipients. CORONARY ARTERY DISEASE: Coronary artery disease of the graft is the leading cause of late mortality. The known risk factors can be limited by normalizing blood pressure and lipidemia and using ATG to prevent rejection. GROWTH OF THE GRAFT IN CHILDREN: Growth of the graft has been demonstrated in 17 recipients aged less than 13 years at the time of transplantation. Growth was linear and followed the child's weight and height curves. Ultrasound measures normalized 6 months after transplantation. PREGNANCY: The graft continues to function normally in female heart transplant recipients during pregnancy and post-portum. Complementary studies are needed to determine the long-term effect.

[Transesophageal electrophysiology study, a simple method of investigation of unexplained illness in elderly patients]. / Etude électrophysiologique par voie transoesophagienne, moyen simple d'investigation de malaises inexpliqués, chez des sujets âgés.

Cardiac arrhythmias are common causes of syncope and malaise in elderly patients, but they are sometimes difficult to demonstrate without invasive procedures. The aim of this report was to demonstrate the value of transoesophageal electrophysiological investigation in cases of negative classical non-invasive studies. The authors report 18 cases of patients, aged 70 to 88, mainly in poor general condition, who were admitted for the investigation of malaise or syncope. The ECG was normal or subnormal and Holter monitoring non-contributive to the diagnosis. Transoesophageal electrophysiological study enabled initiation of an arrhythmia, bradycardia or tachycardia, which reproduced the symptoms of spontaneous malaise. In 10 cases, paroxysmal junctional tachycardia was demonstrated, by nodal reentry in 8 cases, and in a latent Kent bundle in 2 cases. The malaise was caused by tachyarrhythmia in 3 patients and by a vagal reaction or sinus arrest after the tachycardia in the other patients. In 6 other patients, atrial fibrillation reproduced the malaise either due to the rapid rhythm, or to bradycardia after the arrhythmia in 3 cases. In another 2 patients, conduction defects were demonstrated by atrial stimulation (alternating bundle branch block in one patient, complete atrioventricular block at the end of atrial stimulation in another patient). The authors conclude that transoesophageal electrophysiological study is a simple technique which allows diagnosis of unexplained malaise in elderly patients when non-invasive methods are unable to demonstrate the causal arrhythmia. Supraventricular arrhythmias seem to be a common and probably underestimated cause of malaise or syncope in elderly patients.