[Prevalence of late complications and survival of patients undergoing cardiac transplantation: a single-center experience]. / Complicações tardias e sobrevivência após transplantação cardíaca: análise de um centro hospitalar.

INTRODUCTION: Heart transplantation is the treatment of choice in severe heart failure despite maximal medical therapy, which has no other surgical alternatives and exhibiting no contraindications. The aim of this study was to analyze the prevalence of late complications and survival of patients undergoing cardiac transplantation at our Hospital Center. METHODS: We evaluated 78 patients (mean age 43 ± 15 years) transplanted at our center between February 1987 and December 2011, with a mean follow-up of 6 years. RESULTS: Of late complications after heart transplantation, allograft vascular disease was detected in 10 patients ( 12.8%), was the one with impact on mortality, being responsible for four deaths. The most frequent complication was hypertension in 54.6% of cases, followed by dyslipidemia (47.4%), renal failure (47.4%), diabetes mellitus (21.8%) and neoplasms (11.5%). Atrial tachyarrhythmias was observed in eight patients (10.3%). The overall survival of our population at first and tenth year after heart transplantation was 81% and 69%, respectively. The mean survival of patients was 15.6 years (Cl 95%: [12,6-18,7]).. There were 23 deaths (29.5%), nine (11.5%) of which occurred within the first 30 days after transplantation. CONCLUSION: Cardiac transplantation remains a valid therapeutic option for patients with end-stage heart disease. Our center had a heart transplant survival rate and incidence of late complications similar to those seen in international registries.

Pseudoaneurysm of the mitral-aortic fibrosa: myocardial ischemia secondary to left coronary compression.

In the current study we describe the cases of 2 patients operated on for left-sided endocarditis, who later had myocardial ischemia develop secondary to left coronary artery compression from a pseudoaneurysm of the mitral-aortic fibrosa. Because the symptoms of angina persisted despite medical treatment, both patients had second surgeries. Myocardial revascularization was performed in 1 patient; the other patient, who had a severely depressed ventricular function, was given an orthotopic cardiac transplant.

Chronic left ventricular pseudoaneurism.

We present the case of a 70-year-old white male presenting with an abnormal cardiac silhouette on the chest X-ray and complaining of fatigue in the week before hospital admission. Four months before admission he had a single prolonged ischemic chest pain episode. The ECG revealed an old true posterior myocardial infarction. The transthoracic echocardiogram showed a large left ventricular pseudoaneurysm and surgical resection was performed successfully. The etiology, diagnosis and treatment of left ventricular pseudoaneurysm are reviewed.