Sex Differences in Chronic Thromboembolic Pulmonary Hypertension. Treatment Options over Time in a National Referral Center.

(1) Background: Clinical presentation, disease distribution, or treatment received may provide insights into the reasons contributing to sex differences in chronic thromboembolic pulmonary hypertension (CTEPH). (2) Methods: We evaluated 453 patients (56% women) between 2007-2019. Data was collected from REHAP (Registro Español de Hipertensión Arterial Pulmonar) registry. Two time periods were selected to evaluate the influence of new treatments over time. (3) Results: Women were older. Baseline functional class was worse, and distance walked shorter in women compared with men. Women had higher pulmonary vascular resistances. Despite this, pulmonary endarterectomy (PEA) was carried out in more men, and women received more frequently pulmonary vasodilators exclusively. The 2014-2019 interval was associated with a better survival only among women. Interestingly, women had a more distal disease during this second period of time. (4) Conclusions: Even though women were older, and received invasive treatments less frequently, mortality was similar in both sexes. The introduction of balloon pulmonary angioplasty and the improvement of pulmonary endarterectomy, especially during the last years, could be associated with a survival benefit among women.

Feasibility of a Noninvasive Operability Assessment in Chronic Thromboembolic Pulmonary Hypertension under Real-World Practice.

This study aimed to evaluate the feasibility of a noninvasive operability assessment of chronic thromboembolic pulmonary hypertension (CTEPH) based on multidetector computed tomographic angiography (MCTA). Up to 176 patients were evaluated from January 2016 to April 2018. Throughout the first phase, the initial surgical decision was made based on MCTA with further analysis of pulmonary angiography (PA) in order to evaluate in which cases the initial decision was not modified by PA. During the second phase, PA was limited to patients judged inoperable based on MCTA or those whose assessment was not possible. Patients deemed operable (50%) based on MCTA along the first phase had been adequately classified, as PA did not modify the initial decision in all but one patient. Comparable results were obtained throughout the implementation phase. Regarding operated patients, the decision of operability was based solely on MCTA in 94% of those with level I disease, in 75% with level II, and 54% with level III. This approach enabled shorter periods of time to complete surgical assessment and the avoidance of PA-related morbidity. Baseline parameters, postoperative measures, and survival rates at 1 year after surgery were comparable in both phases. Noninvasive operability assessment is feasible in a subset of CTEPH patients and optimizes surgical candidacy evaluation.

Early mortality after heart transplantation related to IgA anti-ß2-glycoprotein I antibodies.

BACKGROUND: The presence of pre-formed IgA anti-ß2-glycoprotein I antibodies (IgA-aB2GP1ab) has been related to early graft loss after kidney transplant. Because ß2-glycoprotein I is produced in both the kidney and heart, we aimed to assess whether the presence of these antibodies may also be associated with poor outcomes after heart transplantation (HT). METHODS: A 2-year follow-up retrospective analysis of 151 consecutive patients who underwent HT between 2004 and 2012 was performed to assess the role of this pre-formed antibody type in HT. The population was divided into 2 groups according to the presence of IgA: Group 1 was positive for IgA-aB2GP1ab (47 patients, 31.1%), and Group 2 was negative for IgA-Ab2GP1ab (104 patients, 68.9%). RESULTS: Early mortality rates within the first 3 months were higher in Group 1 (27.7%) than in Group 2 (9.6%). No differences in donor and recipient characteristics or in causes of death were observed between groups. Multivariate analysis identified the presence of IgA-aB2GP1ab, female gender and blood type A as independent risks factors for early mortality after HT. A greater incidence of thrombotic events during the first 3 months post-HT in Group 1 (23.4% vs 5.8%) and a greater presence of risk factors for thrombotic events, which may have exacerbated them, were observed. After this period, no increase in mortality or in thrombotic events was found when the 2 groups were compared. CONCLUSION: Pre-transplant presence of IgA-aB2GP1ab is associated with both increased early mortality rates and higher thrombotic events after HT.

Endocarditis caused by Arthrographis kalrae.

Arthrographis kalrae is an uncommon etiology in clinical fungal infections. We describe a patient with native aortic valve endocarditis and aortic pseudoaneurysm caused by this agent who required multiple cardiac procedures.

Hipertensión pulmonar tromboembólica crónica: tratamiento mediante tromboendarterectomía quirúrgica / Chronic thromboembolic pulmonary hypertension: surgical treatment with thromboendarterectomy

IntroducciónLa tromboendarterectomía pulmonar (TP) constituye el tratamiento potencialmente curativo de la hipertensión pulmonar tromboembólica crónica (HTPTC). Analizamos los resultados de la aplicación de la TP en nuestra institución.Pacientes y métodosEntre febrero de 1996 y diciembre de 2007 se realizó TP videoasistida a 30 pacientes con HTPTC. Los datos hemodinámicos preoperatorios fueron (valores medios±desviación estándar): presión sistólica pulmonar (PSP), 87±17mmHg; presión arterial pulmonar media (PAPm), 51±11mmHg; resistencia pulmonar total, 1.067±485dinas·s·cm–5; resistencia vascular pulmonar, 873±389dinas·s·cm–5, e índice cardíaco, 2,2±0,5l/min/m2. Se han analizado los factores que influyeron en la mortalidad hospitalaria y la supervivencia, además de realizarse un análisis parcial de la mortalidad a partir de 2004.ResultadosTras la TP se objetivó un descenso tanto de la PSP (p<0,001) como de la PAPm (P=0,001) y un aumento del índice cardíaco (p<0,001). La mortalidad hospitalaria registrada fue del 17% (5/30; intervalo de confianza del 95%, 6–35%); a partir de 2004 se redujo al 5% (1/20; intervalo de confianza del 95%, 0–25%). La resistencia pulmonar total y la resistencia vascular pulmonar preoperatorias, la PSP postoperatoria, el descenso porcentual de la PSP y de la PAPm, la presencia de edema de reperfusión y la persistencia de la HTP evidenciaron asociación con la mortalidad hospitalaria (p=0,036; p=0,018; p=0,013; p=0,050; p=0,050; p=0,030; p=0,045, respectivamente). La supervivencia actuarial a 10 años, incluyendo la mortalidad hospitalaria, fue del 76±9%. Durante el seguimiento mejoró la clase funcional (p=0,001), aumentó la distancia recorrida en la prueba de la marcha de 6min (p=0,001) y se redujeron tanto el diámetro telediastólico del ventrículo derecho (p<0,001) como el grado de regurgitación tricuspídea (p<0,001)(AU)

ConclusionesLa TP mejora la hemodinámica pulmonar, prolonga la supervivencia y optimiza el estado funcional de pacientes con HTPTC(AU)

Background and objectivesPulmonary thromboendarterectomy (PTE) is considered the potential curative treatment for chronic thromboembolic pulmonary hypertension (CTEPH). We analysed the results of the PTE application in our institution.Patients and methodsFrom February 1996 to December 2007, 30 patients with CTEPH underwent video-assisted PTE. Preoperative hemodynamic data were: systolic pulmonary artery pressure (SPAP) 87±17mmHg, mean pulmonary artery pressure (MPAP) 51±11mmHg, pulmonary total resistance 1067±485dynes·s·cm–5, pulmonary vascular resistance 873±389dynes·s·cm–5 and cardiac index 2.2±0.5l/min/m2. We analysed the influence of several factors on hospital mortality and survival, and we performed partial analysis of mortality since 2004.ResultsPTE resulted in significant improvements in SPAP (P<0.001), MPAP (P=0.001) and cardiac index (P<0.001). Hospital mortality was 17% (5/30) (95% confidence interval, 6%-35%). From 2004, it dropped to 5% (1/20) (95% confidence interval, 0%-25%). Hospital mortality was influenced by preoperative pulmonary total resistance, preoperative pulmonary vascular resistance, postoperative SPAP, reduction of SPAP, reduction of MPAP, reperfusion pulmonary oedema and residual postoperative pulmonary hypertension (P=0.036; P=0.018;P=0.013; P=0.050; P=0.050; P=0.030; P=0.045). Survival after PTE, including hospital mortality, was 76±9% at 10 years. Through long-term follow-up, functional status (P=0.001), 6min walking distance (P=0.001), end-diastolic right ventricle size (P<0.001), and tricuspid regurgitation (P<0.001) significantly improved.ConclusionsPTE effectively reduces pulmonary hypertension and offers CTEPH patients a substantial improvement in survival and quality of life(AU)

[Chronic thromboembolic pulmonary hypertension: surgical treatment with thromboendarterectomy]. / Hipertensión pulmonar tromboembólica crónica: tratamiento mediante tromboendarterectomía quirúrgica.

BACKGROUND AND OBJECTIVES: Pulmonary thromboendarterectomy (PTE) is considered the potential curative treatment for chronic thromboembolic pulmonary hypertension (CTEPH). We analysed the results of the PTE application in our institution. PATIENTS AND METHODS: From February 1996 to December 2007, 30 patients with CTEPH underwent video-assisted PTE. Preoperative hemodynamic data were: systolic pulmonary artery pressure (SPAP) 87+/-17mmHg, mean pulmonary artery pressure (MPAP) 51+/-11mmHg, pulmonary total resistance 1067+/-485dynes x s x cm(-5), pulmonary vascular resistance 873+/-389dynes x s x cm(-5) and cardiac index 2.2+/-0.5l/min/m(2). We analysed the influence of several factors on hospital mortality and survival, and we performed partial analysis of mortality since 2004. RESULTS: PTE resulted in significant improvements in SPAP (P<0.001), MPAP (P=0.001) and cardiac index (P<0.001). Hospital mortality was 17% (5/30) (95% confidence interval, 6%-35%). From 2004, it dropped to 5% (1/20) (95% confidence interval, 0%-25%). Hospital mortality was influenced by preoperative pulmonary total resistance, preoperative pulmonary vascular resistance, postoperative SPAP, reduction of SPAP, reduction of MPAP, reperfusion pulmonary oedema and residual postoperative pulmonary hypertension (P=0.036; P=0.018;P=0.013; P=0.050; P=0.050; P=0.030; P=0.045). Survival after PTE, including hospital mortality, was 76+/-9% at 10 years. Through long-term follow-up, functional status (P=0.001), 6min walking distance (P=0.001), end-diastolic right ventricle size (P<0.001), and tricuspid regurgitation (P<0.001) significantly improved. CONCLUSIONS: PTE effectively reduces pulmonary hypertension and offers CTEPH patients a substantial improvement in survival and quality of life.

Early acute aortic dissection of the donor aorta after orthotopic heart transplantation.

Acute type A aortic dissection is an uncommon complication after orthotopic heart transplantation and usually affects the native aorta. Seven cases reported in the literature describe an aortic dissection confined to the donor aorta and only in two of them were they detected during the early postoperative period. We describe the case of a 58-year-old man, the recipient of a cardiac allograft for ischemic cardiomyopathy 20 days earlier, who presented an acute type A aortic dissection limited to the donor aorta. Transesophageal echocardiography revealed severe aortic regurgitation and an intimal tear 2 cm above commissures. The patient was successfully treated with a composite valve graft. This case is the first successful repair in a cardiac allograft with acute aortic dissection of the donor aorta during the early postoperative period using a Bentall procedure.