Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Calcinose/induzido quimicamente , Cardiomiopatia Restritiva/induzido quimicamente , Endocárdio/diagnóstico por imagem , Adulto , Antraciclinas/efeitos adversos , Calcinose/diagnóstico por imagem , Cardiomiopatia Restritiva/diagnóstico por imagem , Cardiomiopatia Restritiva/cirurgia , Cisplatino/efeitos adversos , Ecocardiografia Doppler , Feminino , Átrios do Coração/diagnóstico por imagem , Transplante de Coração , Ventrículos do Coração/diagnóstico por imagem , Humanos , Radiografia , Vincristina/efeitos adversosRESUMO
Little is known about the management of dual-organ transplantation for sickle-cell disease (SCD)-related complications. In this case study, we report the successful outcome of combined heart and kidney transplantation in a patient with SCD. The recipient was a 33-year-old man with homozygous SCD, who developed end-stage heart and renal failure requiring combined heart and kidney transplantation. The patient was managed with pre-operative blood transfusion and moderate hypothermic cardiopulmonary bypass, with limited peri-operative complications. During the first 6 months there was one episode of acute heart rejection without concomitant renal rejection. Eighteen months after surgery, the patient is at home without vaso-occlusive crises or septic complications. Heart and renal allograft function is preserved, without coronary artery vasculopathy, but with asymptomatic moderate transplant renal artery stenosis. SCD is managed by periodic transfusion. This case study demonstrates that combined heart and kidney transplantation is feasible in patients with SCD. Careful attention to peri- and post-operative management is required.
Assuntos
Anemia Falciforme/complicações , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Falência Renal Crônica/complicações , Falência Renal Crônica/cirurgia , Transplante de Rim , Adulto , Humanos , Masculino , Indução de RemissãoRESUMO
OBJECTIVES: We sought to characterize regional myocardial perfusion and contraction in a closed-chest swine model during and after coronary blood flow reduction using myocardial contrast and Doppler tissue echocardiography. METHODS AND RESULTS: Regional myocardial perfusion was assessed by myocardial contrast echocardiography using the corrected contrast peak intensity (baseline-subtracted contrast peak intensity), the peak intensity ratio (contrast peak intensity in ischemic/control wall), and a transmural video-intensity gradient. Regional peak systolic velocities and strain rate were measured using M-mode color Doppler tissue echocardiography. In 12 pigs, coronary blood flow reduction resulted in a significant decrease in peak intensity ratio and in peak systolic velocities in the subendocardium. At baseline and during ischemia, corrected contrast peak intensity and peak systolic velocities in the subendocardium, video-intensity gradient, and strain rate were closely related (r = 0.88 and 0.93, respectively). After reperfusion, in contrast to peak systolic strain rate that remained altered, the peak intensity ratio and video-intensity gradient recovered nearly baseline values. CONCLUSION: The combination of myocardial contrast and Doppler tissue echocardiography may distinguish between ischemic and postischemic myocardial wall dysfunction during severe coronary blood flow reduction.