Heart transplantation in a low-organ-donation environment: a single center experience.

OBJECTIVE: Heart transplantation is the "gold standard" for treating patients in end-stage heart failure who satisfy strict selection criteria. However, infrequent transplant performance, eg, less than nine per year, may be associated with suboptimal results. METHODS: We reviewed our 13-year clinical experience (1996-2008) with 73 orthotopic heart transplants performed under strict selection criteria and followed closely thereafter at the only accredited center in Greece, a country with an annual rate of only seven donors per million population. RESULTS: Low perioperative (5.47%) and long-term (7.5%) mortality rates were responsible for a 94% survival rate in the first year, 92% at five years, and 70% at ten years-similar to those reported worldwide-along with excellent functional recovery. CONCLUSION: Strict recipient and donor selection criteria, combined with a rigorous multidisciplinary follow-up, yield excellent results despite the existing shortage of available grafts.

Mitral valve replacement and Hunter syndrome: case report.

We report a rare case of mitral valve stenosis secondary to Hunter syndrome, mucopolysaccharoidosis (MPS) type II in a 33-year-old man. Anatomical abnormalities in patients with MPS present anesthetic and surgical challenges during cardiac surgery. Management of this particular patient was complicated by excessive oral secretions and atrial fibrillation. With a detailed preoperative assessment and planning for airway management, this patient successfully underwent mitral valve replacement and had an uncomplicated hospital course. After 6 months of follow-up, the patient was still in stable condition.

Inhaled iloprost in eight heart transplant recipients presenting with post-bypass acute right ventricular dysfunction.

BACKGROUND: During heart transplantation, weaning from cardiopulmonary bypass may be particularly laborious as a result of superimposed acute right ventricular dysfunction in the setting of pre-existing pulmonary hypertension. Research in recent years has focused on inhaled vasodilatory treatment modalities which selectively target the pulmonary circulation. METHODS: We present a series of eight patients in whom inhaled iloprost, a synthetic prostacyclin analog, was used to treat pulmonary hypertension and right ventricular dysfunction detected by transesophageal echocardiography during a heart transplant procedure. In addition to conventional inotropic support, 20 mug of inhaled iloprost was administered via nebulized aerosol for a 20-min period. Complete sets of hemodynamic measurements were obtained before inhalation and during and after cessation of the inhalation period. RESULTS: Inhaled iloprost decreased the transpulmonary gradient at the end of the inhalation period relative to baseline (8.2 +/- 1.6 mmHg vs. 11.2 +/- 0.9 mmHg, P < 0.05). The mean pulmonary artery pressure to systemic artery pressure ratio decreased over this period (0.24 +/- 0.07 vs. 0.44 +/- 0.09, P < 0.05). A statistically significant decrease in the pulmonary vascular resistance to systemic vascular resistance ratio was also observed (0.10 +/- 0.02 vs. 0.19 +/- 0.02, P < 0.05). Improved indices of right ventricular function were observed in echocardiographic monitoring. CONCLUSION: During heart transplantation procedures, episodes of pulmonary hypertension can be successfully treated with inhaled iloprost administration, without untoward side-effects or significant systemic impact.

Pedicled pericardial fat pad: a useful hemostatic supplement.

Control of bleeding in areas difficult to suture because of tissue friability, edema, or calcification poses a serious problem in cardiac surgery patients. We report the use of a pedicled pericardial fat pad as an adjunct to the control of bleeding in these difficult-to-suture areas. This technique was used in 9 patients who were bleeding from different areas (the atria, coronary sinus, aorta, and myocardium), and the bleeding was completely and easily controlled. We consider the pedicled pericardial fat pad to be a useful supplement when suturing alone cannot effectively bring the bleeding under control.