Preoperative Cardiac Assessment of Patients Undergoing Orthotopic Liver Transplantation: Experience in One Center.

Preoperative cardiac evaluation of patients undergoing liver transplantation is not well established. Stress testing is used in many centers, and clinical guidelines suggest its use. However, the specificity and sensibility of stress echocardiography to predict coronary lesions have been very low in some studies. Moreover, it has a low positive predictive value to predict complications after liver transplantation. We retrospectively analyzed 143 patients who underwent liver transplantation in our center and report our experience in the use of stress echocardiography. We describe cardiac complications during and after liver transplantation. Low prevalence of ischemic heart disease in asymptomatic patients undergoing liver transplantation make stress testing useless in risk stratification because it has a low positive predictive value. So the risk stratification of these patients before liver transplant surgery remains a challenge.

[Magnetic resonance imaging in apical disease of the left ventricle]. / Resonancia magnética en la patología apical del ventrículo izquierdo.

Visualization of the apex of the left ventricle is crucial in the diagnosis of many of the diseases that affect the heart. Sometimes echocardiography cannot image this region of the heart adequately, which could lead to diagnostic error. Magnetic resonance imaging (MRI) is ideal for the correct definition of the left ventricular apex. We report three cases in which MRI provided valuable information that was unavailable at echocardiography.

[Hypothyroidism and myocardial damage in cardiac donors]. / Hipotiroidismo y daño miocárdico en donantes cardíacos.

BACKGROUND AND OBJECTIVES: Brain death may induce myocardial contractile dysfunction and hypothyroidism. This myocardial dysfunction is a limiting factor when considering donor heart for transplantation. Myocardial damage has shown to be the mechanism in which contractile dysfunction is established in donors. On the other hand, hypothyroidism has been evoked as a major cause of cardiovascular disorders in brain dead subjects. It is not known whether any relationship exists between hypothyroidism and myocardial damage that appear in brain death. In this study myocardial damage and thyroid status are quantified in a donor population, and whether a correlation between hypothyroidism and myocardial damage exists is analyzed. PATIENTS AND METHOD: Serum samples from 45 cardiac donors were examined for cardiac troponins T and I as myocardial damage markers, as well as thyroid hormones. Correlations between cardiac troponins and thyroid hormones were assessed. RESULTS: One or both cardiac troponins were elevated in 19 donors (42.2%). Hypothyroidism was a very frequent finding, since it was present in 39 donors (86.7%). No correlation was observed between any of the myocardial damage markers and thriiodothyronine levels. CONCLUSIONS: Hypothyroidism and myocardial damage are common in brain dead donors. No association exists between both disorders.

[The effect of polymorphisms of the angiotensin-converting enzyme and angiotensinogen genes on the phenotypic expression of Spanish patients with hypertrophic cardiomyopathy]. / Influencia de los polimorfismos de los genes de la enzima conversiva de la angiotensina y del angiotensinógeno en la expresión fenotípica de pacientes españoles con miocardiopatía hipertrófica.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) has a great variability in its morphofunctional expression. This study analyzes whether angiotensin-converting enzyme (ACE) and angiotensinogen (AGT) gene polymorphisms modulate the phenotypic expression in Spanish patients with HCM. PATIENTS AND METHODS: Forty Spanish HCM patients were studied. Twenty-six out of these 40 patients belonged to 7 families with familial HCM, and the remaining 14 patients had either a sporadic HCM or a HCM with unknown family incidence. A group of 269 healthy subjects was included as control for the genotype study. Maximal wall thickness, ventricular mass and several diastolic function indexes were measured in each patient by Doppler-echocardiography. The insertion/deletion (I/D) polymorphism of ACE gene and the M235T polymorphism of AGT gene were studied in both patients and healthy subjects. RESULTS: A higher frequency in patients than in controls was found for D allele (0.79 vs 0.64; p = 0.02) and for DD genotype (62.5 vs 41.2%; p = 0.02). Conversely, no difference was observed in M235T polymorphism between both groups. Neither DD genotype of ACE, nor TT genotype of AGT determined a greater degree of ventricular hypertrophy or a worse diastolic function in patients with HCM. CONCLUSIONS: D allele and DD genotype are predisposing factors to express HCM. In this series of Spanish patients, I/D polymorphism of ACE and M235T polymorphism of AGT do not modify phenotypic expression of HCM.

[Subpulmonary obstruction caused by an aneurysm of the membranous ventricular septum. A study of 2 cases]. / Obstrucción subpulmonar causada por aneurisma del septo ventricular membranoso. Estudio de dos casos.

Aneurysms of the membranous ventricular septum can exceptionally produce subpulmonary obstruction. We report two patients, an 8-year-old and a 2-year-old respectively, with a perimembranous ventricular septal defect and subpulmonic stenosis caused by an aneurysm of the membranous septum. Diagnosis was made by Doppler two-dimensional echocardiography and was confirmed by cardiac catheterization and was surgery. It is shown that this obstruction may appear late due to the growth of the aneurysm. In conclusion, we believe that the appearance of an aneurysm on a ventricular septal defect is not always beneficial, as it may result in right ventricular outflow tract obstruction or other kinds of complications which may require cardiac surgery.

[Exercise physiology and the rehabilitation of the heart transplant patient]. / Fisiología del ejercicio y rehabilitación del corazón trasplantado.

Cardiac transplantation has succeeded in improving the survival of the patients with terminal heart failure spectacularly. Nevertheless, in the transplant recipients the cardiac response to the effort is limited. In order to increase the cardiac output, the denervated heart needs an important increase of the precharge, since its chronotropic response is reduced. This rise of the precharge, in a restrictive heart in itself, leads to a disproportionate increase of the filling pressures. This limits the functional capacity of the patient due to the feeling of dyspnea. A program of cardiac rehabilitation, that includes a physical continued training, gets to improve the physiopathologic response to the exercise of the transplant heart.