Predictors of Tricuspid Valve Anulus Dilation in a Heart Recipient Population.

BACKGROUND: Tricuspid valve regurgitation in reported in >20% of heart recipients. It severity has not only clinical impact, but it is also associated with increased mortality. Risk factors for developing tricuspid valve dysfunction include allograft rejection, donor/recipient pericardial cavity mismatch, preoperative transpulmonary gradient and vascular resistance, biatrial anastomosis technique, and biopsy-induced injury. Tricuspid valve annulus distention is reported to causative factor for most common type of tricuspid valve dysfunction after heart transplantation. The aim of the study was to estimate possible early predictors for tricuspid valve regurgitation after orthotopic heart transplantation performed with standard Lower-Shumway technique on magnetic resonance imaging studies. METHODS: A total of 20 patients (18 men and 2 women) with a mean age of 45 ± 12 years were enrolled into the study. Echocardiographic evaluation followed by magnetic resonance studies were performed. The mean duration from time of transplantation was 34 ± 12 months. Magnetic resonance and echocardiographic imaging focused on tricuspid valve annulus diameter and atrium dimensions. RESULTS: The was a progressive distension of tricuspid valve annulus observed during the follow-up period. Mean tricuspid valve diameter increased from 3.0 ± 0.3 to 3.34 ± 0.3 mm (P < .05). There was a positive correlation observed between recipient native right atrium and overall right atrium diameter and tricuspid valve diameter distension. CONCLUSIONS: Overall right atrium diameter and native recipient right atrium diameter were found to be a risk factor for tricuspid valve annulus distension.

Assessing patient satisfaction with state hospital and aftercare services.

To assess patients' satisfaction with state hospital and aftercare services, the authors administered an open-ended interview to 22 former state hospital patients. The patients expressed marked dissatisfaction with their treatment in the hospital, but 78% said they were helped by the aftercare services. Important components of their satisfaction were feeling helped, feeling understood, and feeling that the aftercare worker was available when needed. Frequency and length of meetings and types of assistance were not related to satisfaction. The patients reported that the psychotherapeutic and task-oriented assistance were equally helpful.

A mental health center's aftercare specialty service for discharged state hospital patients.

To serve discharged state hospital patients from its catchment area, a mental health and retardation center established an ambulatory community service that has total responsiblity for the community care of those patients. The service is staffed primarily by mental health workers and nurses. They become members of the neighborhood-based teams on the state hosptial unit and take part regularly in discharge planning with patients and hospital staff. They also provide a range of continuing outpatient and support services, including medication review, development of housing placements and recreational activities, and psychiatric follow-up. The service operates as a specialized, autonomous unit, which allows it to shift staff resources in line with changes in patient and program needs, to allocate time for program development, and to pressure other agencies to develop needed services.

Transfers from a general hospital psychiatric service to a state hospital.

The authors investigated the marked decline in the number of patients transferred from an inpatient service of a general hospital to a state hospital during a 30-month period. The major reasons for transfer were unmanageable behavior, high risk of suicide or homicide, administrative considerations, and unremitting or deteriorating course. They found that administrative concern about three factors--the many problems of patients likely to be transferred, staff anxiety, and the relationship between the general hospital and state hospital units--can facilitate the decline in the number of patients transferred to a state hospital.

Predictors of community tenure of discharged state hospital patients.

Community treatment of formerly hospitalized patients is in need of evaluation. The authors evaluated an aftercare program by examining its effect on the amount of time spent in the community by patients discharged from a state mental hospital. They assessed the impact of specific intervention in the areas of housing, employment, finances, psychiatric treatment, medication, and leisure. They conclude that assistance during the transition from the hospital to the community prolonged community tenure, that intervention in the areas of housing, finances, and medication was especially important, and that treatment in the community increased the amount of time spent in the community during the first 6 months after discharge.

The effect of deinstitutionalization on a general hospital's inpatient psychiatric service.

As a result of the deinstitutionalization movement, increasing numbers of former state hospital patients are being rehospitalized in general hospital psychiatric units. Because of this change in patient population, the general hospital has had to adjust its treatment strategy to emphasize meticulous review of previous psychiatric history, including medications; plans for meeting the patients' posthospital housing, vocational, and social needs; and development of plans with community care-givers for continuing care. General hospital staff members have to be educated to develop competence in working with the new patient population and a tolerance for chronicity; that can be done through several forums ranging from large staff meetings to individual supervision.