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1.
Transplant Proc ; 49(4): 874-877, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28457415

RESUMO

OBJECTIVE: The aim of this work was to verify the association between clinical and nutritional factors and mortality in the 1st 30 days after heart transplantation. METHODS: This was a retrospective study of patients who underwent heart transplantation in a public hospital in Brazil from January 2013 to August 2015. The clinical and nutritional factors analyzed were: body mass index, body surface area, cachexia, infection, duration of orotracheal intubation, ejection fraction, mean pulmonary pressure, Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) score, hemoglobin, and diabetes mellitus. The primary outcome was mortality in the 1st 30 days after heart transplantation, and secondary outcomes were infection, acute kidney insufficiency, and duration of orotracheal intubation. We performed chi-square test, unpaired t test, and logistic regression in the analyses. A P value of < .05 was considered to be significant. RESULTS: The sample had 103 patients, of which 16 patients (15.53%) died within 30 days after heart transplantation. We observed a relationship between death and orotracheal intubation duration (P < .01), postoperative creatinine (P < .01), acute kidney injury (P < .01), and INTERMACS score (P = .01) in the bivariate analysis but not in the multivariate model. CONCLUSIONS: Clinical and nutritional factors had no impact on mortality up to 30 days after heart transplantation in this study, although orotracheal intubation duration, postoperative creatinine, acute kidney injury, and INTERMACS score were individually associated with early death.


Assuntos
Caquexia/mortalidade , Insuficiência Cardíaca/cirurgia , Transplante de Coração/mortalidade , Intubação Intratraqueal/efeitos adversos , Complicações Pós-Operatórias/mortalidade , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/patologia , Adulto , Idoso , Índice de Massa Corporal , Brasil , Caquexia/etiologia , Caquexia/patologia , Distribuição de Qui-Quadrado , Creatinina/análise , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Sistema de Registros , Estudos Retrospectivos , Volume Sistólico , Fatores de Tempo
3.
Arq. bras. cardiol ; Arq. bras. cardiol;103(6,supl.2): 1-126, 12/2014. tab, graf
Artigo em Português | LILACS | ID: lil-732161
4.
Arq Bras Cardiol ; 101(3 Suppl 3): 1-95, 2013 09.
Artigo em Português | MEDLINE | ID: mdl-24196826
5.
Arq. bras. cardiol ; Arq. bras. cardiol;101(3,supl.3): 1-95, set. 2013. tab
Artigo em Português | LILACS, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: lil-689782
6.
Transplant Proc ; 44(8): 2473-8, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23026623

RESUMO

INTRODUCTION: Endomyocardial biopsy (EMB) plays an important role in allograft surveillance to screen an acute rejection episode after heart transplantation (HT), to diagnose an unknown cause of cardiomyopathies (CMP) or to reveal a cardiac tumor. However, the procedure is not risk free. OBJECTIVE: The main objective of this research was to describe our experience with EMB during the last 33 years comparing surgical risk between HT versus no-HT patients. METHOD: We analyzed retrospectively the data of 5347 EMBs performed from 1978 to 2011 (33 years). For surveillance of acute rejection episodes after HT we performed 3564 (66.7%), whereas 1777 (33.2%) for CMP diagnosis, and 6 (1.0%) for cardiac tumor identification. RESULTS: The main complications due to EMB were divided into 2 groups to facilitate analysis: major complications associated with potential death risk, and minor complications. The variables that showed a significant difference in the HT group were as follows: tricuspid injury (.0490) and coronary fistula (.0000). Among the no-HT cohort they were insufficient fragment (.0000), major complications (.0000) and total complications (.0000). CONCLUSIONS: EMB can be accomplished with a low risk of complications and high effectiveness to diagnose CMP and rejection after HT. However, the risk is great among patients with CMP due to their anatomic characteristics. Children also constitute a risk group for EMB due to their small size in addition to the heart disease. The risk of injury to the tricuspid valve was higher among the HT group.


Assuntos
Biópsia/efeitos adversos , Cardiomiopatias/patologia , Endocárdio/patologia , Rejeição de Enxerto/patologia , Neoplasias Cardíacas/patologia , Transplante de Coração/efeitos adversos , Miocárdio/patologia , Arritmias Cardíacas/etiologia , Biópsia/mortalidade , Brasil , Cardiomiopatias/etiologia , Distribuição de Qui-Quadrado , Rejeição de Enxerto/etiologia , Traumatismos Cardíacos/etiologia , Neoplasias Cardíacas/etiologia , Humanos , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Valva Tricúspide/lesões
7.
Transplant Proc ; 44(8): 2497-500, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23026629

RESUMO

Cardiac complications after liver transplantation are a common cause of death. Stress-induced cardiomyopathy, also called takotsubo cardiomyopathy, is a special form of cardiomyopathy that is precipitated by a stress situation. It can occur after a surgical procedure that results in acute heart failure. Herein we have presented 2 cases of reversible stress-induced cardiac dysfunction early in the period after liver transplantation. Before surgery, cardiac evaluation was normal, with both patients classified as low risk for cardiovascular events during the proposed procedure. Both patients experienced cardiac arrest after graft reperfusion with return of spontaneous circulation after resuscitation. Their early periods after transplantation were characterized by cardiogenic shock secondary to important ventricular dysfunction requiring vasoactive drugs. Subsequent investigations excluded coronary disease. The diagnosis of takotsubo cardiomyopathy was established based on the clinical features and ancillary tests, particularly echocardiography showing apical ballooning. In both cases, ventricular function recovered completely. In conclusion, stress-induced cardiomyopathy, an underestimated cause of heart complications, should be considered as a possible cause of cardiac failure in liver transplant patients.


Assuntos
Transplante de Fígado/efeitos adversos , Cardiomiopatia de Takotsubo/etiologia , Adulto , Evolução Fatal , Feminino , Parada Cardíaca/etiologia , Insuficiência Cardíaca/etiologia , Hemodinâmica , Humanos , Masculino , Recuperação de Função Fisiológica , Choque Cardiogênico/etiologia , Volume Sistólico , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Cardiomiopatia de Takotsubo/fisiopatologia , Cardiomiopatia de Takotsubo/terapia , Resultado do Tratamento , Ultrassonografia , Função Ventricular Esquerda
8.
Arq. bras. cardiol ; Arq. bras. cardiol;98(1,supl.1): 1-33, 2012. ilus, tab
Artigo em Português | LILACS | ID: lil-616896

RESUMO

Esta atualização da Diretriz de Insuficiência Cardíaca Crônica (IC) - 2012 surge para reavaliar as recomendações através de uma avaliação criteriosa das pesquisas (considerando-se a qualidade dos estudos), fundamental para que se atinja esse propósito. Para tanto, foi dada ênfase ao efeito em desfechos de morte, à qualidade "CONSORT" (Consolidated Standards of Reporting Trials), à descrição qualitativa e quantitativa da otimização da medicação, à população realmente incluída, às metanálises somente de estudos qualidade "CONSORT", à custo-efetividade, à existência de efeito de classe, ao número de pacientes incluídos e à análise de subgrupos apenas para gerar hipóteses. Na área da epidemiologia, as recentes abordagens das características da IC com fração de ejeção preservada (ICFEP) e da importância da IC como causa de morte no Brasil foram revisadas. Além disso, este documento contempla a reavaliação do valor dos biomarcadores no diagnóstico e no seguimento da IC, o papel diagnóstico da angiotomografia coronariana nos casos de risco intermediário ou baixo risco de doença coronariana, a não recomendação de rotina do telemonitoramento; o surgimento da avaliação familiar como recomendação importante, e a reavaliação da restrição da adição de sal na dieta. As clínicas de IC e reabilitação física, apesar de alguns resultados negativos ou controversos quanto à mortalidade, continuam com recomendação importante. No campo do tratamento farmacológico, abrange-se a reavaliação da indicação do nebivolol, introduz-se a ivabradina como um novo paradigma no tratamento, os antagonistas da aldosterona não têm efeito de classe reconhecido, o ômega 3 passa a ser recomendado, o ferro administrado por via endovenosa e o sildenafil recebem indicação em casos selecionados. Todas as recomendações para outras etiologias são expandidas para a Doença de Chagas. Na área da anticoagulação, recomenda-se a utilização dos escores CHA2DS2VASC e o HAS-BLED na fibrilação ...


Assuntos
Humanos , Insuficiência Cardíaca/terapia , Brasil , Ensaios Clínicos Controlados como Assunto , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Transplant Proc ; 43(1): 225-8, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21335193

RESUMO

INTRODUCTION: Two-dimensional (2-D) echocardiography is an excellent alternative method to perform endomyocardial biopsies (EB) in special situations, mainly when the patient is in a critical state and cannot go to the catheterization laboratory or when there are contraindications to the use of fluoroscopy as in the pregnancy. OBJECTIVE: This single-center experience analyzed the last 25 years use of an EB technique guided by echocardiography realized at the bedside on critical patients. METHODS: From 1985 to 2010, we performed 76 EB guided by 2-D echocardiography on 59 patients, among whom 38 (64.4%) were critically ill with examinations at the bedside; among 10 (16.9%) subjects, the procedure was carried out simultaneously with fluoroscopy for safety's sake during the learning period. In addition, 8 (13.6%) were unavailable for fluoroscopy, and 3 (5.1%) required a hybrid method due to an intracardiac tumor. RESULTS: The main adverse effects included local pain (n = 4, 5.6%); difficult out successful puncture due to previous biopsies (n = 4, 5.6%); local hematoma without major consequences (n = 3, 4.2%); failed but ultimately successful puncture on the first try due to previous biopsies or (n = 3, 4.2%); obesity and immediate postoperative period with impossibility to pass the bioptome into the right ventricle; however 2 days later the procedure was repeated successfully by echocardiography (n = 1, 1.4%). All myocardial specimens displayed suitable size. There were no undesirable extraction effects on the tricuspid valve tissue. In this series, there was no case of death, hemopericardium, or other major complication as a direct consequence of the biopsy. CONCLUSION: 2-D echocardiography is a special feature to guide EB is mainly in critically ill patients because it can be performed at the bedside without additional risk or disadvantages of fluoroscopy. The hybrid method associating 2-D echocardiography and fluoroscopy allows the procedure in different situations such as intracardiac tumor cases.


Assuntos
Biópsia , Ecocardiografia/métodos , Miocárdio/patologia , Biópsia/efeitos adversos , Humanos
10.
Transplant Proc ; 43(1): 220-4, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21335192

RESUMO

INTRODUCTION: Chagas' disease is endemic in South America. OBJECTIVE: This research reviewed the experience with cardiac transplantation in Chagas' disease, emphasizing reactivation, immunosuppression, and mortality. METHODS: Over 25 years from March 1985 to March 2010, 107/409 (26.2%) patients with Chagas' disease underwent heart transplantation, patients including 74 (71.1%) men and 72 (67.2%), in functional class IV with 33 (30.8%) on vasopressors and 17 (10.7%) on mechanical circulatory support. RESULTS: The diagnosis of disease reactivation was performed by identifying the parasite in the myocardium (n = 23; 71.8%) in the subcutaneous tissue (n = 8; 25.0%), in blood (n = 11; 34.3%), or in central nervous tissue (n = 1; 3.1%). Hospital mortality was 17.7% (n = 19) due to infection (n = 6; 31.5%), graft dysfunction (n = 6; 31.5%), rejection (n = 4; 21.1%), or sudden death (n = 2; 10.5%). Late mortality was 27 (25.2%) cases, which were distributed as: rejection (n = 6; 22.2%), infection (n = 6; 22.2%), (n = lymphoma 4; 14.8%), sarcoma (n = 2; 7.4%), for constrictive pericarditis (n = 2; 7.4%) reactivation of Chagas' disease in the central nervous system (n = 1; 7.1%). CONCLUSIONS: Transplantation in Chagas' disease has peculiar problems that differ from other etiologies due to the possibility of disease reactivation and the increased possibility of emergence of cancers. However, transplantation is the only treatment able to modify the natural progression of the disease in its terminal phase. Early diagnosis and rapid introduction of benzonidazole reverses the histological patterns. Immunosuppression, especially steroids, predisposes to the development of cancer and disease reactivation.


Assuntos
Doença de Chagas/cirurgia , Transplante de Coração , Adolescente , Adulto , Encéfalo/patologia , Doença de Chagas/diagnóstico , Criança , Feminino , Rejeição de Enxerto , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva , Adulto Jovem
11.
Transplant Proc ; 43(1): 229-32, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21335194

RESUMO

INTRODUCTION: Advantages of the bicaval versus the biatrial technique have been reported, emphasizing atrial electrical stability and less tricuspid regurgitation. OBJECTIVE: To analyze the impact of the surgical technique on long-term pulmonary pressures, contractility, and graft valvular behavior after heart transplantation. METHODS: Among 400 orthotopic heart transplantation recipients from 1985 to 2010, we selected 30 consecutive patients who had survived beyond 3 years. The biatrial versus bicaval surgical technique groups included 15 patients each. Their preoperative clinical characteristics were similar. None of the patients displayed a pulmonary vascular resistance or pulmonary artery pressure over 6U Wood or 60 mm Hg, respectively. We evaluated invasive hemodynamic parameters during routine endomyocardial biopsies. Two-dimensional echocardiographic parameters were obtained from routine examinations. RESULTS: There were no significant differences regarding right atrial pressure, systolic pulmonary artery pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, cardiac index, systolic blood pressure, left ventricular ejection fraction, and mitral regurgitation (P > .05). Tricuspid regurgitation increased significantly over the 3 years of observation only among the biatrial group (P = .0212). In both groups, the right atrial pressure, pulmonary wedge capillary pressure, transpulmonary gradient, and pulmonary vascular resistance decreased significantly (P < .05) from the pre- to the postoperative examination. In both groups cardiac index and systemic blood pressure increased significantly after transplantation (P < .05). Comparative analysis of the groups only showed significant differences regarding right atrial pressure and degree of tricuspid regurgitation; the bicaval group showing the best performance. CONCLUSIONS: Both surgical techniques ensure adequate left ventricular function in the long term; however, the bicaval technique provided better trends in hemodynamic performance, as well as a lower incidence and severity of tricuspid valve dysfunction.


Assuntos
Vasos Sanguíneos/fisiopatologia , Transplante de Coração/métodos , Pulmão/irrigação sanguínea , Adulto , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade
13.
Transplant Proc ; 42(2): 535-8, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20304186

RESUMO

BACKGROUND: Heart transplantation (OHT) has traditionally been contraindicated in the presence of severe pulmonary hypertension (PH), as detected by right heart catheterization. Noninvasive methods are still not reliably accurate to make this evaluation. OBJECTIVES: Determine the efficacy of echo Doppler analysis for the diagnosis of severe PH. METHODS: One hundred thirty patients (mean age = 42 +/- 15 years, 82 men) showed severe left ventricular dysfunction (mean ejection fraction = 29 +/- 12%; functional class III-IV). We excluded patients with atrial fibrillation, heart failure secondary to congenital disease, and valvulopathy. The pulmonary parameters defined as severe PH were: systolic pulmonary artery pressure (sPAP) >or= 60 mm Hg; a mean transpulmonary gradient >or= 15; or pulmonary vascular resistance >or= 5 Wood units. Patients underwent a right heart catheterization using a Swan-Ganz catheter to measure hemodynamic parameters and to noninvasively estimate right-sided pressures from spectral Doppler recordings of tricuspid regurgitation velocity (right ventricular systolic pressure [RVsP]). A Pearson correlation of sPAP was obtained with RVsP by; the sensitivity of RVsP for the diagnosis of PH was determined by a receiver operating characteristic (ROC) curve. RESULTS: A good correlation between sPAP and RVsP was obtained by Pearson correlation analysis (r = 0.64; 95% confidence interval [CI] 0.50-0.75; P < .001). The ROC curve analysis showed a sensitivity of 100%, a specificity of 37.2%, (95% CI 0.69-0.83, P < .0001) of a RVsP < 45 mm Hg (cutoff) on the exclusion of severe PH. CONCLUSIONS: The cutoff of RVsP < 45 mm Hg, on noninvasive echo Doppler evaluation of PH is an efficient method to replace invasive heart catheterization in OHT candidates.


Assuntos
Endossonografia/métodos , Transplante de Coração/fisiologia , Hipertensão Pulmonar/diagnóstico por imagem , Volume Sistólico/fisiologia , Adolescente , Adulto , Idoso , Pressão Sanguínea , Cateterismo Cardíaco , Criança , Contraindicações , Ecocardiografia/métodos , Feminino , Ventrículos do Coração/fisiopatologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sístole , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Resistência Vascular
14.
Transplant Proc ; 42(2): 539-41, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20304187

RESUMO

INTRODUCTION: Orthotopic heart transplantation renders the recipient denervated. This remodeling of the intrinsic cardiac nervous system should be taken in account during functional evaluation for allograft coronary artery disease. Dobutamine stress echocardiography (DSE) has been used to detect patients at greater risk. The aim of this study was to determine whether patients with various autonomic response levels, and supposed reinnervation patterns, show the same response to DSE. METHODS: We studied 20 patients who had survived more than 5 years after orthotopic heart transplantation. All patients underwent a Holter evaluation. We considered patients with low variability to be those with less than a 40-bpm variation from the lowest to highest heart rate, so-called "noninnenervated" (group NI). Patients who had 40-bpm or more variation were considered to show high variability and called "reinnervated" (group RI). After that, all patients performed an ergometric test and DSE. RESULTS: Groups were defined as NI (n = 9) and RI (n = 11). Ergometric tests confirmed this response with NI patients showing less variability when compared to RI patients (P = .0401). During DSE, patients showed similar median heart rate responses according to the dobutamine dose. Spearmen correlation showed r = 1.0 (P = .016). CONCLUSIONS: DES was effective to reach higher heart rates, probably related to catecholamine infusion. These findings may justify a better response when evaluating cardiac allograft vasculopathy in heart transplant patients.


Assuntos
Agonistas Adrenérgicos beta , Dobutamina , Ecocardiografia/métodos , Frequência Cardíaca/fisiologia , Transplante de Coração/diagnóstico por imagem , Transplante de Coração/fisiologia , Adulto , Cardiotônicos/efeitos adversos , Angiografia Coronária , Eletrocardiografia , Seguimentos , Transplante de Coração/efeitos adversos , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Sobreviventes , Sístole , Fatores de Tempo
15.
Transplant Proc ; 42(2): 542-4, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20304188

RESUMO

BACKGROUND: Renal failure is the most important comorbidity in patients with heart transplantation, it is associated with increased mortality. The major cause of renal dysfunction is the toxic effects of calcineurin inhibitors (CNI). Sirolimus, a proliferation signal inhibitor, is an imunossupressant recently introduced in cardiac transplantation. Its nonnephrotoxic properties make it an attractive immunosuppressive agent for patients with renal dysfunction. In this study, we evaluated the improvement in renal function after switching the CNI to sirolimus among patients with new-onset kidney dysfunction after heart transplantation. METHODS: The study included orthotopic cardiac transplant (OHT) patients who required discontinuation of CNI due to worsening renal function (creatinine clearance < 50 mL/min). We excluded subjects who had another indication for initiation of sirolimus, that is, rejection, malignancy, or allograft vasculopathy. The patients were followed for 6 months. The creatinine clearance (CrCl) was estimated according to the Cockcroft-Gault equation using the baseline weight and the serum creatinine at the time of introduction of sirolimus and 6 months there after. Nine patients were included, 7 (78%) were males and the overall mean age was 60.1 +/- 12.3 years and time since transplantation 8.7 +/- 6.1 years. The allograft was beyond 1 year in all patients. There was a significant improvement in the serum creatinine (2.98 +/- 0.9 to 1.69 +/- 0.5 mg/dL, P = .01) and CrCl (24.9 +/- 6.5 to 45.7 +/- 17.2 mL/min, P = .005) at 6 months follow-up. CONCLUSION: The replacement of CNI by sirolimus for imunosuppressive therapy for patients with renal failure after OHT was associated with a significant improvement in renal function after 6 months.


Assuntos
Transplante de Coração/fisiologia , Testes de Função Renal , Sirolimo/uso terapêutico , Idoso , Inibidores de Calcineurina , Creatinina/metabolismo , Feminino , Seguimentos , Transplante de Coração/efeitos adversos , Transplante de Coração/imunologia , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Insuficiência Renal/epidemiologia , Insuficiência Renal/etiologia , Insuficiência Renal/prevenção & controle , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Sirolimo/efeitos adversos , Fatores de Tempo
16.
Transplant Proc ; 41(3): 799-801, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19376356

RESUMO

UNLABELLED: Organ transplant shortage is a global problem caused by several factors, most of which are related to members of the family, who play a major role in the donation process. OBJECTIVE: We sought to determine the most determinant features in the donor profile that relate to positive decisions versus refusal of donation. MATERIAL AND METHODS: Fifty-six families who were approached by the Organ Procurement Organization (OPO) from November 2004 to April 2006 agreed to participate in this work. To assess donor profiles, we used a structured interview. RESULTS: Parental involvement directly in decisions about donation lead to significantly less frequent consent (P = .005), young donor age was associated with a reduced probability of donation (P = .002), violent death negatively influenced donation consent, excluding suicide (P = .004). CONCLUSION: The present study showed violent death, young patient age, and parental donation consent to be the most important factors that make it harder to obtain consent organ donation. When a collateral relative (sibling/uncle) or children were responsible for the donation decision, there was more success of consent.


Assuntos
Comportamento , Família , Consentimento Livre e Esclarecido , Recusa de Participação , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/métodos , Adulto , Atitude Frente a Morte , Atitude Frente a Saúde , Morte Encefálica , Tomada de Decisões , Escolaridade , Feminino , Humanos , Renda , Entrevistas como Assunto , Masculino , Relações Profissional-Família , Religião , Obtenção de Tecidos e Órgãos/estatística & dados numéricos
17.
Transplant Proc ; 41(3): 935-7, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19376392

RESUMO

OBJECTIVE: Endomyocardial biopsy (EMB), which is used to monitor for rejection, may cause tricuspid regurgitation (TR) after orthotopic heart transplantation (OHT). The purpose of this investigation was to examine the occurrence of tricuspid valve tissue in myocardial specimens obtained by routine EMB performed after OHT. PATIENTS AND METHODS: From January 2000 to July 2008, 125 of the patients who underwent OHT survived more than 1 month. Their follow-up varied from 1 month to 8.5 years (mean, 5.1 +/- 3.7 years). EMB was the gold standard examination and myocardial scintigraphy with gallium served as a screen to routinely monitor rejection. RESULTS: Each of 428 EMB including 4 to 7 fragments, totaling 1715 fragments, were reviewed for this study. The number of EMB per patient varied from 3 to 8 (mean, 4.6 +/- 3.5). Histopathological analysis of these fragments showed tricuspid tissue in 4 patients (3.2%), among whom only 1 showed aggravation of TR. CONCLUSIONS: EMB remains the standard method to diagnose rejection after OLT. It can be performed with low risk. Reducing the number of EMB using gallium myocardial scintigraphy or other alternative methods as well as adoption of special care during the biopsy can significantly minimize trauma to the tricuspid valve.


Assuntos
Biópsia/efeitos adversos , Transplante de Coração/patologia , Insuficiência da Valva Tricúspide/patologia , Valva Aórtica/patologia , Biópsia/métodos , Seguimentos , Humanos , Valva Mitral/patologia , Valva Pulmonar/patologia , Estudos Retrospectivos , Fatores de Risco , Valva Tricúspide/patologia
18.
Transplant Proc ; 41(3): 962-4, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19376399

RESUMO

OBJECTIVE: Arrhythmogenic right ventricular dysplasia (ARVD) is a myocardial disease of familiar, origin where the myocardium is replaced by fibrofatty tissue predominantly in the right ventricle. Herein we have presented the clinical courses of 4 patients with ARVD who underwent orthotopic heart transplantation. PATIENTS AND METHODS: Among 358 adult patients undergoing heart transplantation, 4 (1.1%) displayed ARVD. The main indication for transplantation was the progression to heart failure associated with arrhythmias. All 4 patients displayed rapid, severe courses leading to heart failure with left ventricular involvement and uncontrolled arrhythmias. RESULTS: In all cases the transplantation was performed using a bicaval technique with prophylactic tricuspid valve annuloplasty. One patient developed hyperacute rejection and infection, leading to death on the 7th day after surgery. The other 3 cases showed a good evolution with clinical remission of the symptoms. Pathological study of the explanted hearts confirmed the presence of the disease. CONCLUSIONS: ARVD is a serious cardiomyopathy that can develop malignant arrhythmias, severe ventricular dysfunction with right ventricular predominance, and sudden cardiac death. Orthotopic heart transplantation must always be considered in advanced cases of ARVD with malignant arrhythmias or refractory congestive heart failure with or without uncontrolled arrhythmias, because it is the only way to remit the symptoms and the disease.


Assuntos
Arritmias Cardíacas/etiologia , Arritmias Cardíacas/cirurgia , Transplante de Coração/métodos , Disfunção Ventricular Direita/cirurgia , Adolescente , Cardiomiopatias/etiologia , Cardiomiopatias/genética , Cardiomiopatias/cirurgia , Cromossomos Humanos , Eletrocardiografia , Feminino , Genes Dominantes , Transplante de Coração/mortalidade , Humanos , Masculino , Adulto Jovem
19.
Transplant Proc ; 41(3): 965-6, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19376400

RESUMO

Extreme myocardial degeneration leading to advanced stages of cardiomyopathy with extensive atrophy is rarely observed before patients die. However, heterotopic transplantation is a special situation wherein this phenomenon can be observed. The greater part of the failed heart shows recuperation after receiving circulatory assistance by reduction of myocardial work. Herein we have reported an unusual behavior of degenerative cardiomyopathy associated with intense myocardial apoptosis resulting in extreme ventricular atrophy after heterotopic heart transplantation. An 11-year-old girl with end-stage heart failure due to dilated cardiomyopathy of undetermined etiology without pulmonary hypertension underwent heterotopic cardiac transplantation with an undersized (by weight mismatch) donor heart. After 9 years heart failure reappeared due to native heart enlargement leading to allograft compression. The patient underwent native heart replacement leaving her with 2 donor hearts. Despite normal hemodynamic recuperation, the patient experienced massive arterial microemboli which led to death. Pathological studies showed exuberant myocardial degeneration in the native heart with intense atrophy of the muscle and gigantic ventricular enlargement. The left ventricle wall was extremely thin with rarefaction of cardiomyocytes and replacement by fibrosis. The right ventricle showed old extensive thrombosis. In conclusion, this report is not usual as it is not frequent to observe cardiomyopathy with an intense degree of myocardial degeneration and atrophy, because the patient dies earlier. In special situations it is possible that a recipient may have 2 donor hearts with normal hemodynamics. Heterotopic heart transplantation is a surgical alternative in a priority situation offering excellent outcomes; however, the native heart must be removed when there is compromise of the function of the heterotopic allograft.


Assuntos
Cardiomiopatia Dilatada/cirurgia , Transplante de Coração/métodos , Miocárdio/patologia , Transplante Heterotópico/métodos , Adulto , Atrofia , Criança , Evolução Fatal , Feminino , Seguimentos , Coração/anatomia & histologia , Transplante de Coração/efeitos adversos , Humanos , Tamanho do Órgão , Reoperação , Transplante Heterotópico/efeitos adversos , Transplante Homólogo/efeitos adversos
20.
Heart ; 95(3): 181-9, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18977804

RESUMO

Continued assessment of temporal trends in mortality and epidemiology of specific cardiovascular diseases in South America is needed to provide a scientific basis for rational allocation of the limited healthcare resources and introduction of strategies to reduce risk and predict the future burden of cardiovascular disease. The epidemiology of cardiomyopathies, adult valve disease and heart failure (HF) in South America is reviewed here. Diseases of the circulatory system are the main cause of death based on data from about 50% of the South American population. Among the cardiovascular causes of death, cerebrovascular disease is predominant followed by ischaemic heart disease, other heart diseases and hypertensive disease. Of note, cerebrovascular disease is the main cause of death in women, and race also influenced cardiovascular mortality rates. HF is the most important cardiovascular reason for admission to hospital due to cardiovascular disease of ischaemic, idiopathic dilated cardiomyopathic, valvular, hypertensive and chagasic aetiologies. Also, mortality due to HF is high, especially owing to Chagas' disease. HF and aetiologies associated with HF are responsible for 6.3% of deaths. Rheumatic fever is the leading cause of valvular heart disease. The findings have important public health implications because the allocation of healthcare resources, and strategies to reduce the risk of HF should also consider controlling Chagas' disease and rheumatic fever in South American countries.


Assuntos
Cardiomiopatias/mortalidade , Insuficiência Cardíaca/mortalidade , Doenças das Valvas Cardíacas/mortalidade , Hipertensão/mortalidade , Idoso , Brasil/epidemiologia , Cardiomiopatias/etiologia , Cardiomiopatias/terapia , Ensaios Clínicos como Assunto , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Doenças das Valvas Cardíacas/etiologia , Doenças das Valvas Cardíacas/terapia , Humanos , Hipertensão/complicações , Hipertensão/terapia , América Latina/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Saúde Pública/tendências , Comportamento de Redução do Risco
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