Subject(s)
Cardiac Valve Annuloplasty , Cardiomyopathy, Dilated/surgery , Echocardiography , Heart-Assist Devices , Ventricular Dysfunction, Left/surgery , Adult , Cardiomyopathy, Dilated/diagnostic imaging , Cardiomyopathy, Dilated/drug therapy , Cardiomyopathy, Dilated/rehabilitation , Humans , Male , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/drug therapy , Ventricular Dysfunction, Left/rehabilitation , Young AdultABSTRACT
BACKGROUND: Thyroid hormones are essential for the correct functioning of the entire body. Diagnosis of thyroid disorders in patients after heart transplant in the early post-operative period and the implementation of correct treatment may prevent life-threatening complications. MATERIAL/METHODS: The aim of the study was to determine whether the complicated postoperative course (ie, hypothyroidism, hyperthyroidism or low fT3 syndrome) in patients in the first month after heart transplantation was connected with impaired thyroid hormone management. The analysis encompassed material from 98 patients treated with heart transplantation between February 9, 2004 and January 4, 2010. Hyperthyroidism was diagnosed in 21 patients (19M/2F, 52±7 years of age), hypothyroidism in was diagnosed in 13 patients (10M/3F, 46±12 years old), and low fT3 syndrome was diagnosed in 18 patients (14M/4F, 43±12 years old). RESULTS: Patients with fT3 syndrome had the highest mortality (16.7%, NS), highest incidence of acute rejection (38.9%, NS), highest number of reoperations (27.8%, NS), and highest incidence of bacterial (16.7%, NS) and fungal infections (11.1%, NS). Cytomegaloviral infections occurred most frequently in patients with hyperthyroidism (23.8%, NS). Patients with hypothyroidism (84.6%, NS) were hospitalized the longest (>30 days), had the highest tendency towards pleural effusion (23.1%, NS) and pericardial effusion with tamponade (15.5%, NS), bradycardia with pacemaker (15.4%, NS) and renal failure requiring hemodiafiltration (15.4%, NS) (Table 1). CONCLUSIONS: 1. The thyroid test panel should be performed in all patients in the early post-heart transplant period. 2. The diagnosis of thyroid disorders should be immediately followed by correct treatment aimed at restoring the euthyroid state, with a view to facilitate recovery and rehabilitation as well as to shorten the hospitalization time, thereby lowering treatment costs.
Subject(s)
Heart Transplantation/adverse effects , Postoperative Complications/etiology , Thyroid Diseases/etiology , Acute Kidney Injury/etiology , Adult , Euthyroid Sick Syndromes/diagnosis , Euthyroid Sick Syndromes/drug therapy , Euthyroid Sick Syndromes/etiology , Female , Graft Rejection , Heart Transplantation/mortality , Humans , Hyperthyroidism/diagnosis , Hyperthyroidism/drug therapy , Hyperthyroidism/etiology , Hypothyroidism/diagnosis , Hypothyroidism/drug therapy , Hypothyroidism/etiology , Infections/etiology , Male , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/drug therapy , Reoperation , Retrospective Studies , Risk Factors , Thyroid Diseases/diagnosis , Thyroid Diseases/drug therapy , Time FactorsABSTRACT
BACKGROUND: Transplanted heart coronary artery disease (TxCAD) is the most frequent casue of death occuring > or =5 years after orthotopic heart transplantation (OHT). Considering three basic therapeutic approaches - percutaneous coronary intervention (PCI), surgical revascularisation and retransplantation - PCI seems to be the superior method due to its safety and good short-term results, however, the long-term efficacy of PCI has been less well established. AIM: To evaluate long-term results of PCI in the treatment of OHT recipients with TxCAD. METHODS: The study group consisted of 20 patients (19 males, aged 24-63, median 45.5 years; 14 (70%) had before OHT), who underwent single or multiple PCI of significant coronary lesions, revealed by elective (n=17) or urgent (n=3) coronary angiography (CAG). The overall number of PCI procedures was 26, including 8 with stent implantation. procedures were performed 9-151 (median 61.5) months after OHT. Analysis of PCI results was based on the follow-up CAGs or autopsy in case of death. RESULTS: Follow-up time was 3-90 (median 28) months. At least one CAG was performed in 17 (85%) patients - the overall number of follow-up CAGs was 53. Progression of TxCAD was revealed by 33 (62%) CAGs - the decision to perform subsequent single or multiple PCI was undertaken in 22 (42%) patients. The overall number of re-PCI procedures was 38 (with stent implantation in 11 cases). Out of 38 PCI procedures without stent implantation, significant restenosis was found on control CAG in 16 (42%) patients, and out of 16 PCI with stents -- in 11 (69%) patients, including 8 haemodynamically significant lesions. TxCAD was the cause of 5 out of 9 deaths that occurred during follow-up. CONCLUSIONS: PCI is unable to stop TxCAD development in the majority of patients. Stent implantation does not improve long-term results of TxCAD treatment.
