ABSTRACT
BACKGROUND: Fixed pulmonary hypertension is common in patients with advanced heart failure and is a contraindication for heart transplantation. Left ventricular assist devices (LVAD) and inotropes have been used to reduce pulmonary vascular resistance (PVR) and allow transplantation. However, little is known about the efficacy of this strategy. METHODS: We queried the United Network for Organ Sharing registry for all adult patients (age ≥18 years) listed for primary heart transplantation (2008-2014) with PVR of >5 wood units (WU) or transpulmonary gradient >16 mmHg who were treated with LVAD or IV inotropes as status 1a, 1b, or 7. We compared waitlist mortality/delisting and absolute changes in hemodynamics between listing and transplantation. RESULTS: Of 18,009 patients listed during the study period, 1016 were included in the analysis (393 LVAD, 623 inotropes), with a mean age of 52.9 ± 11.6 years, 74% male, and 38% had ischemic etiology. Mean PVR was 5.7 ± 2.4 WU and transpulmonary pressure gradient 19.3 ± 5.3 mmHg. Compared with the inotrope group, LVAD patients were more likely listed as status 1A (32.8% vs 18.1%, P < .001), had lower PVR (5.3 WU vs 5.9 WU, P = .001), and higher cardiac output (4.1 vs 3.6 L/min, P < .001). After a mean of 239 days, PVR decreased by 1.71 WU in the LVAD group vs 1.85 WU in the inotrope group (P = .52). PVR normalization (<2.5 WU) occurred at similar rates among those treated with inotropes and LVAD (30.7% vs 35.6%, P = .228). Waitlist mortality was similar between LVAD and inotropes (adjusted P = .837). Absolute PVR and transpulmonary pressure gradient reductions correlated with time on the waitlist (P < .001 for both comparisons). CONCLUSION: Only about one-third of patients with fixed pulmonary hypertension achieve normalization of PVR before transplant with either LVAD or inotropes. Similar waitlist mortality was observed among patients bridged with either strategy.
Subject(s)
Cardiotonic Agents/therapeutic use , Heart Failure/therapy , Heart Transplantation , Heart-Assist Devices , Hypertension, Pulmonary/therapy , Vascular Resistance/physiology , Waiting Lists , Female , Follow-Up Studies , Heart Failure/complications , Heart Failure/physiopathology , Humans , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/physiopathology , Male , Middle Aged , Retrospective StudiesSubject(s)
Cardiac Catheterization/methods , Heart Failure/therapy , Heart Valve Prosthesis Implantation/methods , Heart-Assist Devices , Hemodynamics , Mitral Valve Stenosis/surgery , Mitral Valve/surgery , Ventricular Function, Left , Aged , Bioprosthesis , Cardiac Catheterization/instrumentation , Echocardiography, Transesophageal , Heart Failure/complications , Heart Failure/diagnosis , Heart Failure/physiopathology , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation/instrumentation , Humans , Male , Mitral Valve/physiopathology , Mitral Valve Stenosis/complications , Mitral Valve Stenosis/diagnosis , Mitral Valve Stenosis/physiopathology , Prosthesis Design , Recovery of Function , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
A 63-year-old woman with a history of hyperlipidemia presented to our hospital with a swollen right hand. The patient noted that she had closed her hand in a car door one week earlier, causing minor trauma to the right third metacarpophalangeal joint. Shortly after injuring her hand, she'd sought care at an outpatient facility, where she was given a diagnosis of cellulitis and a prescription for an oral antibiotic. The swelling, however, worsened, prompting her visit to our hospital.
Subject(s)
Anticoagulants/therapeutic use , Cellulitis/etiology , Upper Extremity Deep Vein Thrombosis/diagnostic imaging , Upper Extremity Deep Vein Thrombosis/drug therapy , Diagnosis, Differential , Edema/complications , Edema/diagnostic imaging , Female , Forearm Injuries/complications , Forearm Injuries/diagnostic imaging , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Middle Aged , Ultrasonography , Upper Extremity Deep Vein Thrombosis/pathologySubject(s)
Herpes Zoster Ophthalmicus/diagnosis , Herpesvirus 3, Human , Skin Diseases, Viral/diagnosis , Antiviral Agents/therapeutic use , Diagnosis, Differential , Exanthema , Face , Herpes Zoster Ophthalmicus/drug therapy , Herpesvirus 3, Human/isolation & purification , Humans , Male , Middle Aged , Skin Diseases, Viral/drug therapyABSTRACT
Osteosarcoma is a rare cardiac malignant tumor. This case of cardiac osteosarcoma presented with atrial fibrillation. Initial echocardiogram demonstrated mitral valve echodensity and mitral valve regurgitation. Surgery and histopathological examination identified the tumor as an osteosarcoma. Tumor grade appeared to be prognostically important in cardiac sarcoma, with poor prognosis in high-grade tumors.
