Coronary artery abnormalities in Puerto Rico

A retrospective study was done to determine the frequency of coronary artery anomalies in terms of their origin, course, and structure. The clinical history, catheterization data and surgical reports of patients undergoing coronary angiography at the Cardiovascular Center of Puerto Rico and the Caribbean, from 1999 to 2004, were analyzed. Thirty-eight patients were identified with a coronary artery anomaly in this population. These anomalies were classified according to their clinical consequences and the need for surgical intervention.

Heart transplantation in females: the experience in Puerto Rico

BACKGROUND: Heart transplantation is the procedure of choice for a selected group of patients with end stage heart disease. Gender related differences have been observed in the heart transplant field: less women than men are recipients of heart transplants, more risk of rejection in female recipients, and a perception toward reduced survival in women. We report our experience of heart transplantation in females in Puerto Rico. METHODS: We studied the data bank of 69 heart transplant recipients in the Puerto Rico Heart Transplant Program from June 1999 to June 2005. Gender related differences in the number of recipients: males or females, incidence of rejection, survival, and other outcomes were analyzed. RESULTS: 69 patients received an orthotopic heart transplant from June 1999 to June 2005, in a single center in Puerto Rico. The mean age of the patients was 47 (11-62) years. Fifty patients (72%) were men, and 19 patients (28%), were women. Survival in the female group at 3 months, 1, 2, 3, 4, and 5 years was 100%, 100%, 100%, 100%, 90%, and 90% respectively. The survival in the male group at 3 months, 1, 2, 3, 4 and 5 years was 97%, 97%, 97%, 94%, 86 and 79% respectively. There was an early, higher incidence of rejection in women during the first three months post transplant; 1.5 vs. 0.75, (P=0.04) episodes per patient in the female, and male group respectively. After the third month post transplant there was no significant difference in rejection incidence. The incidence of infectious episodes was significantly more frequent in female than in male recipients, 2.8 vs. 1 (P=0.02) per patient respectively. CONCLUSIONS: There were more male than female heart transplant recipients at a ratio of 3:1, without a significant gender difference in survival. The risk of rejection was higher in females in the early period post transplantation, but thereafter this risk showed no signinificant statistical difference. The incidence of infection was more frequent in female...

Solid tumors after heart transplantation: lethality of lung cancer.

BACKGROUND: Prolonged nonspecific immunosuppression after solid-organ transplantation is associated with an increased risk of certain cancers. This study examined the development of solid-organ tumors after cardiac transplantation. METHODS: Thirty-eight solid tumors were identified in 36 (5.9%) of 608 cardiac transplant recipients who survived more than 30 days. Two patients had two types of skin tumors (basal cell and squamous cell). The tumors included the following types: skin (15), lung (10), breast (1), bladder (2), larynx (2), liver (1), parotid (1), testicle (1), uterus (2), melanoma (2), and Merkel's cell (1). Four immunosuppression regimens based on cyclosporin A or FK 506 were used during this period. RESULTS: There was no association between the incidence of solid tumors and the use of lympholytic therapy. After the diagnosis of tumor was made, the actuarial 2-year survival rates of recipients with skin, lung, and other solid tumors were 71%, 22%, and 23%, respectively. Eight of 10 patients with lung cancer were in stage IIIA or higher at the time of diagnosis. CONCLUSION: Skin and lung tumors are the most frequent solid tumors in heart transplant recipients. Skin tumors (except Merkel's cell carcinoma and melanoma) usually have a benign course, whereas lung and other tumors developing in cardiac transplant recipients carry a poor prognosis. Advanced disease stage at the time of diagnosis is responsible for the dismal outcome of recipients in whom solid tumors develop. Close postoperative tumor surveillance after cardiac transplantation is warranted.

Extra-adrenal pheochromocytoma

We have presented our experience in the diagnosis and management of three patients with extra-adrenal pheochromocytomas. Only two had hypertension, although all three had increased catecholamine production. The third patient was normotensive preoperatively and remained normotensive after the immediate postoperative period. Two patients are alive and without evidence of disease, the third patient died from what was considered to be a malignant pheochromocytoma. All three patients presented with palpable masses, confirmed by computerized tomography

Extra-adrenal pheochromocytoma.

We have presented our experience in the diagnosis and management of three patients with extra-adrenal pheochromocytomas. Only two had hypertension, although all three had increased catecholamine production. The third patient was normotensive preoperatively and remained normotensive after the immediate postoperative period. Two patients are alive and without evidence of disease, the third patient died from what was considered to be a malignant pheochromocytoma. All three patients presented with palpable masses, confirmed by computerized tomography.

Some aspects of clinical & anesthetic management of heart transplantation.

Heart transplantation has become a widely and frequently used therapeutic approach for end stage cardiac disease. However, there is no absolute agreement concerning certain aspects related to the clinical and anesthetic management of the donor and the recipient. The most common indications for heart transplantation are the dilated cardiomyopathy of idiopathic origin and the ischemic cardiomyopathy. There are several contraindications for transplantation. Once a patient is initially accepted as a possible candidate for transplantation, it is important to rule out the presence of fixed pulmonary vascular hypertension, since its presence has been associated with dismal results. The immunosuppression protocols are multiple and diverse. Use of sterile intubation techniques, rapid induction anesthesia and vasopressors as needed are the hallmarks of the anesthetic management of the recipient. Among the most challenging problems in the immediate post-operative period are the low cardiac output and the control of potassium balance. These and other problems will be addressed in the following article.

Some aspects of clinical & anesthetic management of heart transplantation

El transplante de corazón se ha convertido en uma terapia utilizada con relativa frecuencia para el tratamiento de enfermedad cardíaca en etapa final. Sin embargo, no existe acuerdo absoluto con respecto a ciertos aspectos relacionados con el manejo clínico y de anestesia del donante y menos aun del recipiente. Las condiciones que más comunmnete se citan como causa para transplante cardíaco lo son la cardiomiopatia dilatada de origen idiopático y la cardiomiopatía de origen isquémico. Existen múltiples contraindicaciones para transplante cardíaco. Sin embargo, una vez se decide evaluar un paciente como candidato a transplante es esencial, en la etapa inicial de evaluación, descartar la presencia de resistencia pulmonar aumentada, pues se han demostrado pobrísimos resultados en presencia de esta entida. El uso de técnicas estériles de intubación, inducción anestésica rápida y el uso de vasopresores son los aspectos más sobresalientes en el manejo anestésico del recipiente. Entre los problemas más comunes en el período post-operatorio inmediato se cuentan el débito cardíaco disminuido y problemas con la regulación de electrolitos. Algunos de estos aspectos se revisan en el seguiente artículo

Physiology of the denervated heart: a review.

The physiology of the transplanted organ is discussed. The cardiac allograft can sustain almost all the functions of the normal organ, however it possesses intrinsic properties that modify its response to exercise and pharmacologic agents. For this reason the physiology of the transplanted heart is reviewed.

Physiology of the denervated heart: a review

Fisiología del corazón denervado. Se discute la fisiología del corazón transplantado. El órgano transplantado puede llevar a cabo todas las funciones del corazón normal, sin embargo éste posee propiedades intrinsecas que modifican su respuesta al ejercicio y a los agentes farmacológicos. Se hace un repaso de la literatura sobre este tema