Assuntos
Humanos , Masculino , Feminino , Ecocardiografia/métodos , Transplante de Coração , Adulto , Endocardite , Doenças das Valvas Cardíacas , Cardiomiopatias , Valva Aórtica , Artéria Pulmonar , Embolia Pulmonar , Fibrilação Atrial , Doença da Artéria Coronariana , Guias como Assunto/normas , Terapia de Ressincronização Cardíaca/métodos , Intervenção Coronária Percutânea/métodos , Ventrículos do Coração , Hipertensão , NeoplasiasRESUMO
INTRODUCTION: Infection remains a major complication among heart transplant (HT) recipients, causing approximately 20% of deaths in the first year after transplantation. In this population, Aspergillus spp. can have various clinical presentations including invasive pulmonary aspergillosis (IPA), with high mortality (53-78%). OBJECTIVES: To establish the characteristics of IPA infection in HT recipients and their outcomes in our center. METHODS: Among 328 HTs performed in our center between 1998 and 2016, we identified five cases of IPA. Patient medical records were examined and clinical variables were extracted. RESULTS: All cases were male, and mean age was 62 years. The most common indication for HT was non-ischemic dilated cardiomyopathy. Productive cough was reported as the main symptom. The radiological assessment was based on chest X-ray and chest computed tomography. The most commonly reported radiographic abnormality was multiple nodular opacities in both techniques. Bronchoscopy was performed in all patients and Aspergillus fumigatus was isolated in four cases on bronchoalveolar lavage culture. Treatment included amphotericin in four patients, subsequently changed to voriconazole in three, and posaconazole in one patient, with total treatment lasting an average of 12 months. Neutropenia was found in only one patient, renal failure was observed in two patients, and concurrent cytomegalovirus infection in three patients. All patients were alive after a mean follow-up of 18 months. CONCLUSIONS: IPA is a potentially lethal complication after HT. Early diagnosis and prompt initiation of aggressive treatment are the cornerstone of better survival.
Assuntos
Transplante de Coração/efeitos adversos , Aspergilose Pulmonar Invasiva/mortalidade , Complicações Pós-Operatórias/mortalidade , Transplantados , Idoso , Seguimentos , Humanos , Aspergilose Pulmonar Invasiva/diagnóstico , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Taxa de Sobrevida/tendências , Tomografia Computadorizada por Raios XAssuntos
Cardiomiopatia Chagásica/congênito , Cardiomiopatia Chagásica/patologia , Transplante de Coração , Adulto , Biópsia , Cardiomiopatia Chagásica/diagnóstico por imagem , Cardiomiopatia Chagásica/cirurgia , Eletrocardiografia , Humanos , Imageamento por Ressonância Magnética , Masculino , Radiografia Torácica , Recidiva , Trypanosoma cruzi/isolamento & purificaçãoAssuntos
Insuficiência Cardíaca/cirurgia , Transplante de Coração/efeitos adversos , Ventrículos do Coração , Trombose/etiologia , Adolescente , Angiografia por Tomografia Computadorizada , Ecocardiografia , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Humanos , Imageamento Tridimensional , Masculino , Trombose/diagnósticoRESUMO
INTRODUCTION AND OBJECTIVES: Dilated cardiomyopathy (DCM) is a myocardial disease that can progress to a terminal stage, requiring heart transplantation. In this work we aim to contribute to knowledge of genetic variants in adult patients undergoing heart transplantation due to end-stage DCM, reporting the results obtained in our single-center tertiary hospital series using target next-generation sequencing (NGS). METHODS AND RESULTS: Genetic variants were screened in 15 genes, preselected based on variants previously identified in DCM patients. Thirteen unrelated patients were included, nine (69%) male, mean age at diagnosis 33±13 years, eight (62%) with familial DCM. Nine genetic variants were identified in six (46%) patients: five in LMNA, two in LBD3, one in TNNT2 and one in TCAP. These variants were new in most patients. The majority were classified as of uncertain significance. Two patients were double and triple heterozygotes in the LBD3 and LMNA genes, respectively. CONCLUSION: Our results highlight the potential of NGS in the genetic characterization of DCM patients. LMNA is one of the most frequently mutated genes and should be included in all target gene assessments of end-stage DCM patients until more data are available.
Assuntos
Cardiomiopatia Dilatada/genética , DNA/genética , Transplante de Coração , Lamina Tipo A/genética , Mutação , Adulto , Cardiomiopatia Dilatada/cirurgia , Análise Mutacional de DNA , Feminino , Seguimentos , Variação Genética , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Lamina Tipo A/metabolismo , Masculino , Pessoa de Meia-Idade , FenótipoRESUMO
Existem poucos sistemas de avaliação de mortalidade após transplante cardíaco (TC) que se baseiem em fatores relacionados com o doador e que sejam capazes de predizer o prognóstico. Identificar características dos doadores que têm impacto na sobrevida depois do TC pode contribuir para melhorar os resultados e a alocação de órgãos. Aplicamos um sistema de avaliação americano para predizer a mortalidade pós-TC em uma coorte brasileira. Objetivo: Avaliar um escore americano como preditor de mortalidade depois de TC em uma coorte brasileira. Métodos: Análise de uma base de dados de um centro de TC brasileiro de 2013 a 2015. Foram avaliadas quatro características dos doadores: tempo de isquemia, idade do doador, discordância racial doador/receptor e a função renal do doador. A sobrevida foi estimada pelo teste de log-rank em faixas de pontuação pré-determinadas. Resultados: Foram 110 doadores, 89% homens e 62% brancos. A principal causa de morte foi trauma (66,6%). Os doadores tinham em média 29,8 anos, 18,6 de relação Nitrogênio da ureia sanguínea / Creatinina, 175 minutos de tempo de isquemia e 42% de discordância racial com o receptor. Não houve diferença de sobrevida entre as faixas de pontuação. Conclusão: Apesar de preditor de mortalidade após transplante cardíaco em uma população americana, esse escore não foi útil para uma coorte de transplante brasileira. As diferenças, inclusive a alta taxa de miscigenação pode ser uma explicação para esses achados
here are few systems to assess mortality after heart transplantation (CT) that are based on donor-related factors and can predict prognosis. Identifying donor characteristics that impact post-CT survival can contribute to improved outcomes and organ allocation. We applied a US evaluation system to predict mortality after CT in a Brazilian cohort. Objective: To evaluate an American score as a predictor of mortality following CT in a Brazilian cohort. Method: Database analysis of a Brazilian CT center from 2013 to 2015. Four donor characteristics were evaluated: ischemia time, donor age, donor-recipient race mismatch, and donor renal function. Survival was estimated by the log-rank test in predetermined score ranges. Results: There were 110 donors, 89% male and 62% white. The main cause of death was trauma (66.6%). Donors had a mean age of 29.8 years, a mean blood urea nitrogen / creatinine ratio of 18.6, a mean ischemia time of 175 minutes, and race mismatch with the recipient of 42%. There was no difference in survival between the score ranges. Conclusion: Although it was a predictor of mortality after cardiac transplantation in an American population, this score was not useful for a Brazilian transplant cohort. Differences, including the high rate of miscegenation, may explain these findings
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Doadores de Tecidos , Transplante/mortalidade , Transplante de Coração/mortalidade , Prognóstico , Doenças Cardiovasculares , Análise de Sobrevida , Prevalência , Valor Preditivo dos Testes , Estudos de Coortes , Resultado do Tratamento , Insuficiência Cardíaca/terapiaRESUMO
OBJECTIVE: to verify the association between the prognostic scores and the quality of life of candidates for heart transplantation. METHOD: a descriptive cross-sectional study with a convenience sample of 32 outpatients applying to heart transplantation. The prognosis was rated by the Heart Failure Survival Score (HFSS) and the Seattle Heart Failure Model (SHFM); and the quality of life by the Minnesota Living With Heart Failure Questionnaire (MLHFQ) and the Kansas City Cardiomyopathy Questionnaire (KCCQ). The Pearson correlation test was applied. RESULTS: the correlations found between general quality of life scores and prognostic scores were (HFSS/MLHFQ r = 0.21), (SHFM/MLHFQ r = 0.09), (HFSS/KCCQ r = -0.02), (SHFM/KCCQ r = -0.20). CONCLUSION: the weak correlation between the prognostic and quality of life scores suggests a lack of association between the measures, i.e., worse prognosis does not mean worse quality of life and the same statement is true in the opposite direction.
Assuntos
Transplante de Coração/normas , Seleção de Pacientes , Qualidade de Vida , Inquéritos e Questionários/normas , Adulto , Idoso , Estudos Transversais , Feminino , Transplante de Coração/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Reprodutibilidade dos Testes , Índice de Gravidade de DoençaRESUMO
Cardiovascular diseases are the major cause of death worldwide. The heart has limited capacity of regeneration, therefore, transplantation is the only solution in some cases despite presenting many disadvantages. Tissue engineering has been considered the ideal strategy for regenerative medicine in cardiology. It is an interdisciplinary field combining many techniques that aim to maintain, regenerate or replace a tissue or organ. The main approach of cardiac tissue engineering is to create cardiac grafts, either whole heart substitutes or tissues that can be efficiently implanted in the organism, regenerating the tissue and giving rise to a fully functional heart, without causing side effects, such as immunogenicity. In this review, we systematically present and compare the techniques that have drawn the most attention in this field and that generally have focused on four important issues: the scaffold material selection, the scaffold material production, cellular selection and in vitro cell culture. Many studies used several techniques that are herein presented, including biopolymers, decellularization and bioreactors, and made significant advances, either seeking a graft or an entire bioartificial heart. However, much work remains to better understand and improve existing techniques, to develop robust, efficient and efficacious methods.
Assuntos
Transplante de Coração/métodos , Miocárdio/citologia , Engenharia Tecidual/métodos , Biopolímeros , Reatores Biológicos , Técnicas de Cultura de Células/métodos , Transplante de Coração/tendências , Humanos , Engenharia Tecidual/tendências , Tecidos SuporteRESUMO
BACKGROUND: Heart failure (HF) is a severe public health problem because of its high morbidity and mortality and elevated costs, thus requiring better understanding of its course. In its complex and multifactorial pathogenesis, sympathetic hyperactivity plays a relevant role. Considering that sympathetic dysfunction is already present in the initial phases of chronic Chagas cardiomyopathy (CCC) and frequently associated with a worse prognosis, we assumed it could be more severe in CCC than in cardiomyopathies of other etiologies (non-CCC). OBJECTIVES: To assess the cardiac sympathetic dysfunction 123I-MIBG) of HF, comparing individuals with CCC to those with non-CCC, using heart transplant (HT) patients as denervated heart parameters. METHODS: We assessed 76 patients with functional class II-VI HF, being 25 CCC (17 men), 25 non-CCC (14 men) and 26 HT (20 men), by use of cardiac 123I-metaiodobenzylguanidine 123I-MIBG) scintigraphy, estimating the early and late heart-to-mediastinum ratio (HMR) of 123I-MIBG uptake and cardiac washout (WO%). The 5% significance level was adopted in the statistical analysis. RESULTS: The early and late HMR values were 1.73 ± 0.24 and 1.58 ± 0.27, respectively, in CCC, and 1.62 ± 0.21 and 1.44 ± 0.16 in non-CCC (p = NS), being, however, higher in HT patients (p < 0.001). The WO% values were 41.65 ± 21.4 (CCC), 47.37 ± 14.19% (non-CCC) and 43.29 ± 23.02 (HT), p = 0.057. The late HMR values showed a positive weak correlation with left ventricular ejection fraction (LVEF) in CCC and non-CCC (r = 0.42 and p = 0.045; and r = 0.49 and p = 0.015, respectively). CONCLUSION: Sympathetic hyperactivity 123I-MIBG) was evidenced in patients with class II-IV HF, LVEF < 45%, independently of the HF etiology, as compared to HT patients.
Assuntos
3-Iodobenzilguanidina/administração & dosagem , Cardiomiopatia Chagásica/complicações , Insuficiência Cardíaca/diagnóstico por imagem , Transplante de Coração , Disautonomias Primárias/diagnóstico por imagem , Compostos Radiofarmacêuticos/administração & dosagem , Adulto , Cardiomiopatia Chagásica/fisiopatologia , Estudos Transversais , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Disautonomias Primárias/etiologia , Disautonomias Primárias/fisiopatologia , CintilografiaRESUMO
INTRODUCTION: Heart transplantation is still the best therapeutic alternative for the treatment of end-stage heart failure. The use of criteria that consider the complications associated with this procedure can guarantee a better evaluation of the recipient and prepare the team for possible unsatisfactory post-transplant results. The use of the MELD score has been expanded to evaluate cirrhotic patients undergoing various procedures, including cardiac transplantation. OBJECTIVE: To analyze the knowledge on MELD score and its derivatives to the prognosis of patients with end-stage heart failure considered for heart transplantation. METHOD: Was carried out an integrative review of the publications of the last ten years in Pubmed and Lilacs databases, using the descriptors "heart transplantation", "liver disease" and "prognosis". From the total of 111 articles found, six were selected and composed the sample. RESULTS: The MELD-XI score (eXcluding INR) was the most analyzed in the studies due to the exclusion of INR, since many patients with heart failure use anticoagulants, which may alter their value. MELD and derivatives were associated with unsatisfactory results in cardiac transplantation. CONCLUSION: The MELD score can be considered as a good predictor for heart transplantation; however, there are still few studies that make this correlation.
Assuntos
Doença Hepática Terminal/complicações , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Humanos , Modelos Teóricos , PrognósticoRESUMO
Relatamos um caso peculiar de taquicardia de QRS largo incessante em portador de coração transplantado ortotópico por técnica de anastomose biatrial 13 anos antes do aparecimento da arritmia. O paciente foi submetido, com sucesso, a ablação guiada por mapeamento eletroanatômico, evidenciando a importância desse método e potenciais armadilhas de mapeamento em arritmias associadas a cicatrizes cirúrgicas
We report a peculiar case of an incessant wide complex QRS tachycardia in a patient with orthotopic heart transplant using a bi-atrial anastomosis technique, performed thirteen years before the appearance of the arrhythmia. The patient underwent a successful ablation procedure guided by electroanatomic mapping, evidencing the importance of this method and potential pitfalls in tachyarrhythmias associated with surgical scars
Assuntos
Humanos , Masculino , Adulto , Período Pós-Operatório , Taquicardia , Transplante de Coração , Ablação por Cateter/métodos , Trombose , Ecocardiografia/métodos , Heparina/administração & dosagem , Cintilografia/métodos , Eletrocardiografia/métodos , Eletrofisiologia/métodos , Cateteres , Átrios do CoraçãoRESUMO
INTRODUCTION AND AIMS: Selecting patients for heart transplantation is challenging. We aimed to identify the most important risk predictors in heart failure and an approach to optimize the selection of candidates for heart transplantation. METHODS: Ambulatory patients followed in our center with symptomatic heart failure and left ventricular ejection fraction ≤40% prospectively underwent a comprehensive baseline assessment including clinical, laboratory, electrocardiographic, echocardiographic, and cardiopulmonary exercise testing parameters. All patients were followed for 60 months. The combined endpoint was cardiac death, urgent heart transplantation or need for mechanical circulatory support, up to 36 months. RESULTS: In the 263 enrolled patients (75% male, age 54±12 years), 54 events occurred. The independent predictors of adverse outcome were ventilatory efficiency (VE/VCO2) slope (HR 1.14, 95% CI 1.11-1.18), creatinine level (HR 2.23, 95% CI 1.14-4.36), and left ventricular ejection fraction (HR 0.96, 95% CI 0.93-0.99). VE/VCO2 slope was the most accurate risk predictor at any follow-up time analyzed (up to 60 months). The threshold of 39.0 yielded high specificity (97%), discriminated a worse or better prognosis than that reported for post-heart transplantation, and outperformed peak oxygen consumption thresholds of 10.0 or 12.0 ml/kg/min. For low-risk patients (VE/VCO2 slope <39.0), sodium and creatinine levels and variations in end-tidal carbon dioxide partial pressure on exercise identified those with excellent prognosis. CONCLUSIONS: VE/VCO2 slope was the most accurate parameter for risk stratification in patients with heart failure and reduced ejection fraction. Those with VE/VCO2 slope ≥39.0 may benefit from heart transplantation.
Assuntos
Insuficiência Cardíaca/cirurgia , Transplante de Coração , Seleção de Pacientes , Feminino , Insuficiência Cardíaca/fisiopatologia , Testes de Função Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de RiscoRESUMO
Heart transplantation (HTx) is considered an efficient and gold-standard procedure for patients with end-stage heart failure. After surgery, patients have lower aerobic power (VO2max) and compensatory hemodynamic responses. The aim of the present study was to assess through a systematic review with meta-analysis whether high-intensity interval training (HIIT) can provide benefits for those parameters. This is a systematic review with meta-analysis, which searched the databases and data portals PubMed, Web of Science, Scopus, Science Direct and Wiley until December 2016 (pairs). The following terms and descriptors were used: "heart recipient" OR "heart transplant recipient" OR "heart transplant" OR "cardiac transplant" OR "heart graft". Descriptors via DeCS and Mesh were: "heart transplantation'' OR "cardiac transplantation". The words used in combination (AND) were: "exercise training" OR "interval training" OR "high intensity interval training" OR "high intensity training" OR "anaerobic training" OR "intermittent training" OR "sprint training". The initial search identified 1064 studies. Then, only those studies assessing the influence of HIIT on the post-HTx period were added, resulting in three studies analyzed. The significance level adopted was 0.05. Heart transplant recipients showed significant improvement in VO2peak, heart rate and peak blood pressure in 8 to 12 weeks of intervention.
Assuntos
Transplante de Coração/reabilitação , Treinamento Intervalado de Alta Intensidade/normas , Transplantados , Feminino , Humanos , Masculino , Consumo de Oxigênio/fisiologiaRESUMO
BACKGROUND: Peripartum cardiomyopathy is an idiopathic disorder defined by the occurrence of acute heart failure during late pregnancy or post-partum period in the absence of any other definable cause. Its clinical course is variable and severe cases might require heart transplantation. OBJECTIVE: To investigate long-term outcomes after heart transplantation (HT) for peripartum cardiomyopathy (PPCM). METHODS: Out of a single-center series of 1938 HT, 14 HT were performed for PPCM. We evaluated clinical characteristics, transplant-related complications, and long-term outcomes, in comparison with 28 sex-matched controls. Primary endpoint was death from any cause; secondary endpoints were transplant-related complications (rejection, infection, cardiac allograft vasculopathy). A value of p < 0.05 was considered of statistical significance. RESULTS: PPCM patients and matched controls were comparable for most variables (all p values > 0.05), except for a higher use of inotropes at the time of HT in PPCM group (p = 0.03). During a median follow-up of 7.7 years, 16 patients died, 3 (21.5%) in PPCM group and 13 (46.5%) in control group. Mortality was significantly lower in PPCM group (p = 0.03). No significant difference was found in terms of transplant-related complications (p > 0.05). CONCLUSIONS: Long-term outcomes following HT for PPCM are favorable. Heart transplantation is a valuable option for PPCM patients who did not recover significantly under medical treatment.
Assuntos
Cardiomiopatias/complicações , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Complicações Cardiovasculares na Gravidez/cirurgia , Adulto , Cardiomiopatias/imunologia , Cardiomiopatias/mortalidade , Feminino , França/epidemiologia , Rejeição de Enxerto/imunologia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/imunologia , Insuficiência Cardíaca/mortalidade , Transplante de Coração/mortalidade , Coração Auxiliar , Humanos , Pessoa de Meia-Idade , Período Periparto , Período Pós-Parto , Gravidez , Estudos RetrospectivosRESUMO
A histoplasmose é uma infecção sistêmica causada por um fungo dimórfico, comumente encontrado em solo contaminado por fezes de aves e morcegos. Em indivíduos imunocompetentes, cerca de 95% das infecções são assintomáticas, mas ocasionalmente a inalação de conídios pode causar manifestações pulmonares agudas ou crônicas. Indivíduos transplantados estão suscetíveis às infecções, mesmo no seguimento tardio do pós-operatório. Essas infecções, em pacientes imunossuprimidos, podem ser de difícil diagnóstico com quadros clínicos atípicos e alto risco de complicações. É relatado um caso de histoplasmose pulmonar em um jovem de 15 anos, transplantado há seis anos, que evoluiu para sepse, insufi ciência renal e respiratória, com consequente imobilismo e redução da capacidade funcional. O tratamento clínico e a intervenção fisioterapêutica, por meio de aplicação de ventilação não invasiva e programa de treinamento físico com cargas progressivas, resultaram em reversão da insuficiência respiratória e restabelecimento da capacidade funcional, respectivamente, com alta hospitalar após 57 dias de internação
Histoplasmosis is a systemic infection caused by a dimorphic fungus commonly found in the ground contaminated by feces from birds and bats. In immunocompetent individuals, about 95% of infections are asymptomatic, but occasionally the inhalation of conidia can cause acute or chronic pulmonary manifestations. Transplanted individuals are susceptible to infections even at late postoperative follow-up. These infections, in patients immunosuppressed, may be difficult to diagnose with atypical clinical high risk of complications. One case of pulmonary histoplasmosis is reported in a 15-year-old man, transplanted six years ago, who progressed to sepsis, renal and respiratory failure, resulting in immobility and reduced functional capacity. Clinical treatment and physical therapy intervention, through the application of noninvasive ventilation and physical training program with progressive loads, resulted in reversion of respiratory failure and restoration of functional capacity, then hospital discharge after 57 days of hospitalization