RESUMO
Little is known either about either physical activity patterns, or other lifestyle-related prevention measures in heart transplantation (HTx) recipients. The history of HTx started more than 50 years ago but there are still no guidelines or position papers highlighting the features of prevention and rehabilitation after HTx. The aims of this scientific statement are (i) to explain the importance of prevention and rehabilitation after HTx, and (ii) to promote the factors (modifiable/non-modifiable) that should be addressed after HTx to improve patients' physical capacity, quality of life and survival. All HTx team members have their role to play in the care of these patients and multidisciplinary prevention and rehabilitation programmes designed for transplant recipients. HTx recipients are clearly not healthy disease-free subjects yet they also significantly differ from heart failure patients or those who are supported with mechanical circulatory support. Therefore, prevention and rehabilitation after HTx both need to be specifically tailored to this patient population and be multidisciplinary in nature. Prevention and rehabilitation programmes should be initiated early after HTx and continued during the entire post-transplant journey. This clinical consensus statement focuses on the importance and the characteristics of prevention and rehabilitation designed for HTx recipients.
Assuntos
Insuficiência Cardíaca , Transplante de Coração , Qualidade de Vida , Humanos , Consenso , Europa (Continente) , Exercício Físico , Insuficiência Cardíaca/reabilitação , Insuficiência Cardíaca/cirurgia , Transplante de Coração/efeitos adversos , Sociedades MédicasRESUMO
Right heart failure (RHF) following implantation of a left ventricular assist device (LVAD) is a common and potentially serious condition with a wide spectrum of clinical presentations with an unfavourable effect on patient outcomes. Clinical scores that predict the occurrence of right ventricular (RV) failure have included multiple clinical, biochemical, imaging and haemodynamic parameters. However, unless the right ventricle is overtly dysfunctional with end-organ involvement, prediction of RHF post-LVAD implantation is, in most cases, difficult and inaccurate. For these reasons optimization of RV function in every patient is a reasonable practice aiming at preparing the right ventricle for a new and challenging haemodynamic environment after LVAD implantation. To this end, the institution of diuretics, inotropes and even temporary mechanical circulatory support may improve RV function, thereby preparing it for a better adaptation post-LVAD implantation. Furthermore, meticulous management of patients during the perioperative and immediate postoperative period should facilitate identification of RV failure refractory to medication. When RHF occurs late during chronic LVAD support, this is associated with worse long-term outcomes. Careful monitoring of RV function and characterization of the origination deficit should therefore continue throughout the patient's entire follow-up. Despite the useful information provided by the echocardiogram with respect to RV function, right heart catheterization frequently offers additional support for the assessment and optimization of RV function in LVAD-supported patients. In any patient candidate for LVAD therapy, evaluation and treatment of RV function and failure should be assessed in a multidimensional and multidisciplinary manner.
RESUMO
Little is known either about either physical activity patterns, or other lifestyle-related prevention measures in heart transplantation (HTx) recipients. The history of HTx started more than 50 years ago but there are still no guidelines or position papers highlighting the features of prevention and rehabilitation after HTx. The aims of this scientific statement are (i) to explain the importance of prevention and rehabilitation after HTx, and (ii) to promote the factors (modifiable/non-modifiable) that should be addressed after HTx to improve patients' physical capacity, quality of life and survival. All HTx team members have their role to play in the care of these patients and multidisciplinary prevention and rehabilitation programmes designed for transplant recipients. HTx recipients are clearly not healthy disease-free subjects yet they also significantly differ from heart failure patients or those who are supported with mechanical circulatory support. Therefore, prevention and rehabilitation after HTx both need to be specifically tailored to this patient population and be multidisciplinary in nature. Prevention and rehabilitation programmes should be initiated early after HTx and continued during the entire post-transplant journey. This clinical consensus.
RESUMO
Little is known either about either physical activity patterns, or other lifestyle-related prevention measures in heart transplantation (HTx) recipients. The history of HTx started more than 50 years ago but there are still no guidelines or position papers highlighting the features of prevention and rehabilitation after HTx. The aims of this scientific statement are (i) to explain the importance of prevention and rehabilitation after HTx, and (ii) to promote the factors (modifiable/non-modifiable) that should be addressed after HTx to improve patients' physical capacity, quality of life and survival. All HTx team members have their role to play in the care of these patients and multidisciplinary prevention and rehabilitation programmes designed for transplant recipients. HTx recipients are clearly not healthy disease-free subjects yet they also significantly differ from heart failure patients or those who are supported with mechanical circulatory support. Therefore, prevention and rehabilitation after HTx both need to be specifically tailored to this patient population and be multidisciplinary in nature. Prevention and rehabilitation programmes should be initiated early after HTx and continued during the entire post-transplant journey. This clinical consensus statement focuses on the importance and the characteristics of prevention and rehabilitation designed for HTx recipients.
RESUMO
No disponible
Assuntos
Humanos , Políticas Editoriais , Doenças Cardiovasculares , Publicações Periódicas como AssuntoRESUMO
Debido a la evolución de la cirugía cardiaca y la cardiología, los pacientes pediátricos que antaño fallecían a causa de cardiopatías congénitas actualmente llegan a la edad adulta. Los pacientes con transposición de grandes vasos y reparación fisiológica en el seguimiento pueden evolucionar hacia la insuficiencia cardiaca, como consecuencia del fallo progresivo del ventrículo derecho en posición sistémica. En esta situación, el trasplante cardiaco aparece como una posible alternativa terapéutica. Las alteraciones anatómicas y la presencia de conductos intraauriculares hacen que el trasplante precise de una serie de variaciones técnicas. Presentamos la experiencia en nuestro centro. Entre 1992 y 2004 se han realizado cuatro trasplantes cardiacos en transposición de grandes vasos y corrección fisiológica. No hubo mortalidad quirúrgica. Durante el seguimiento (media, 75 meses), se produjo una muerte por rechazo crónico. Los demás pacientes presentan clase I de la NYHA, con injerto normofuncionante
Thanks to progress in cardiac surgery and cardiology, pediatric patients with complex congenital heart conditions who would previously have died are now reaching adulthood. Patients with transposition of the great arteries who have undergone atrial repair can present during follow-up with progression towards heart failure as a result of progressive systemic right ventricular failure. In this situation, heart transplantation is a possible therapeutic option. Anatomic abnormalities and the presence of intraatrial conduits ensure that transplantation must involve a number of technical modifications. Here, we present our experience during 1992-2004 with heart transplantations in four patients with transposition of the great arteries and atrial repair. There was no operative mortality. During follow-up (mean period, 75 months), there was one death due to chronic rejection. The other patients remain in New York Heart Association class I, with normally functioning grafts
Assuntos
Humanos , Transplante de Coração/métodos , Transposição dos Grandes Vasos/cirurgia , Cardiopatias Congênitas/cirurgia , Insuficiência Cardíaca/prevenção & controleRESUMO
FUNDAMENTO Y OBJETIVO: El origen respiratorio o cardíaco de la disnea no siempre es fácil de establecercon las herramientas diagnósticas disponibles. Muchos pacientes presentan a la vez procesoscardiológicos y pulmonares que la justifica. El papel que puede desempeñar el recuentode hemosiderófagos (RH) en esputo en este contexto no ha sido establecido suficientemente.El objetivo fue determinar la utilidad en la predicción y el diagnóstico del RH en pacientes condisnea de origen cardíaco, y si varía tras el tratamiento.PACIENTES Y MÉTODO: Hemos realizado el RH a 61 pacientes que consultaron por disnea en urgenciasy cuyo origen fue determinado por la historia clínica de urgencias, el curso clínico y la realizaciónde pruebas funcionales respiratorias y ecocardiograma.RESULTADOS: El RH fue superior en los pacientes con disnea de origen cardíaco (n = 35), 37%(intervalo de confianza [IC] del 95%, 26-47) o de origen cardiopulmonar (n = 9), 30% (IC del95%, 8-52) que el de origen respiratorio (n = 17), 15% (IC del 95%, 4-27). La sensibilidad(52%), especificidad (88%), valores predictivos positivo (92%) y negativo (58%) se determinaronpara un punto de corte del RH del 30%. El modelo de predicción de disnea de origen cardíaco,incluido el RH, presentó un área bajo la curva ROC de 0,978 (IC del 95%, 0,95-1).CONCLUSIONES: El RH refleja la gravedad de la alteración de la permeabilidad venocapilar pulmonar,identifica a la mayoría de los pacientes que presentan o han presentado disfunción o insuficienciacardíaca moderada o grave y predice la disnea de origen cardíaco. Su utilidad debecentrarse en casos seleccionados
BACKGROUND AND OBJECTIVE: The respiratory or heart origin of dyspnea is not always easy to findout using the available diagnostic tools. Many patients present both heart and lung diseasesthat cause dyspnea. The role of hemosiderin-laden macrophages count (HC) in sputum in thiscontext has not been well settled so far. The objective was to describe the prediction usefulnessof HC in patients suffering from dyspnea of heart origin, and to find out if HC changed afteradministering treatment.PATIENTS AND METHOD: HC was analized in 61 patients whose main symptom was dyspnea in theemergency department, and it was evaluated by means of clinical history, clinical course andperformance of lung function tests and echocardiography.RESULTS: 35 patients were classified as having dyspnea of heart origin, 17 as having dyspnea oflung origin and 9 had dyspnea of both origins. The HC was higher in patients with dyspnea ofheart origin 37% (95% CI, 26-47) or cardiopulmonary origin 30% (95% CI,, 8-52) than in patientswith dyspnea of lung origin 15% (95% CI, 4-27), and it remained higher despite administeringtreatment. The sensitivity (52%), specificity (88%), positive predictive value (92%)and negative predictive value (58%) was established for a 30% HC cutoff. The prediction modelof heart origin dyspnea presented an area under the ROC curve of 0.978 (95% CI, 0.95-1).CONCLUSIONS: HC reflects the severity of pulmonary venocapillar disturbance,identifies the majority of patients suffering from current or past heart failure or severe cardiacdysfunction, and is useful for the prediction of dyspnea of heart origin. HC utility should focuson selected patients