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1.
Int Heart J ; 61(6): 1311-1314, 2020 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-33191338

RESUMO

Although some researches proved the influence of radiation therapy (RT) on pacemakers and implantable cardioverter defibrillators, little has been reported on cardiac resynchronization therapy defibrillators (CRTDs). We experienced a case of RT on CRTD and had a new finding.A patient with CRTD implanted for dilated cardiomyopathy was diagnosed with lung squamous cell carcinoma and started receiving RT. All the implanted devices, including the main body of CRTD, left ventricular lead (LV), right ventricular lead with high-voltage conductor, and right atrial lead, were from the same manufacturer. The radiation targeted the tumor of 67 mm in diameter in the right superior lobe for 5 min per session. The CRTD was outside the radiation field, which is 65 mm, but the leads were inside. Plan 1 used 2 Gy/fr with 8 megavolt photons, and Plan 1 was irradiated at 0° and 180° for 16 RT sessions. The dosage was increased to 3 Gy for Plan 2 for 4 sessions. Plan 3 used 2 Gy with 6 and 8 megavolt photons, and Plan 3 was irradiated at 27.7° and 200.7° for 11 RT sessions. Changes in measured parameters were assessed before and after RT.Changes in impedance of LV and high-voltage lead exceeded prespecified threshold. However, no significant errors were detected in the CRTD on the dosages and energy we used.We hypothesize that the lead insulator could have been affected by radiation.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Dispositivos de Terapia de Ressincronização Cardíaca , Cardiomiopatia Dilatada/terapia , Desfibriladores Implantáveis , Neoplasias Pulmonares/radioterapia , Radioterapia/métodos , Idoso , Carcinoma de Células Escamosas/complicações , Terapia de Ressincronização Cardíaca , Cardiomiopatia Dilatada/complicações , Impedância Elétrica , Eletrodos Implantados , Humanos , Neoplasias Pulmonares/complicações , Masculino
2.
Sci Rep ; 10(1): 16528, 2020 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-33020564

RESUMO

Indoxyl sulfate (IS) is associated with either chronic kidney disease or renal failure, which may predict cardiovascular events via cardiorenal syndrome. The present study aimed to elucidate whether the plasma levels of IS can predict the occurrence of cardiovascular events in patients with chronic heart failure (CHF) and investigate which causes of CHF leading to cardiovascular events are highly influenced by plasma IS levels. We measured the plasma IS levels in 165 patients with CHF [valvular disease: 78, dilated cardiomyopathy: 29, hypertrophic cardiomyopathy (HCM): 25 and others: 33] admitted to our hospital in 2012, and we followed up these patients for more than 5 years (the median follow-up period: 5.3 years). We measured the plasma IS level in 165 patients with CHF, and Kaplan-Meier analyses showed that high plasma IS levels (≥ 0.79 µg/mL, the median value) could predict the occurrence of cardiovascular events, i.e., cardiovascular death or rehospitalization due to the worsening of CHF. The sub-analyses showed that the high IS level could predict cardiovascular events in patients with CHF due to HCM and that the plasma IS levels were closely associated with left ventricular (LV) dimension, LV systolic dysfunction, and plasma B-type natriuretic peptide levels, rather than LV diastolic dysfunction. Plasma IS level predicts cardiovascular events in patients with CHF, especially those with HCM along with cardiac dysfunction. Besides, IS may become a proper biomarker to predict cardiovascular events in patients with CHF.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Indicã/análise , Adulto , Idoso , Biomarcadores/sangue , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Hipertrófica/complicações , Fenômenos Fisiológicos Cardiovasculares/genética , Doença Crônica , Feminino , Insuficiência Cardíaca/metabolismo , Humanos , Indicã/sangue , Indicã/metabolismo , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Plasma/química , Prognóstico , Disfunção Ventricular Esquerda/complicações
3.
J Biol Regul Homeost Agents ; 34(4 Suppl. 2): 71-77, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33000604

RESUMO

Mucolipidosis II and III are lysosomal storage diseases caused by pathogenetic mutations in GNPTAB and GNPTG genes which cause an impaired activity of the lysosomal hydrolase N-acetylglucosamine- 1-phosphotransferase, a key enzyme in the synthesis of the mannose-6-phosphate targeting signals on lysosomal enzymes. Patients with MLII alpha/beta present coarse facial features, cessation of statural growth, important skeletal manifestations, impaired neuromotor development and cardiorespiratory involvement. All children appear to have cardiac involvement, but severe dilated cardiomyopathy is uncommon. In this report we describe the case of an 11-month-old girl who is affected by a MLII. Analysis of the GNPTAB gene identified at a heterozygous level the previously described gene variants c. 2693delA p(Lys898Serfs*13) and c. 2956C>T p(Arg986Cys). Her main clinical features were coarse face with gingival hypertrophy, dysostosis multiplex, recurrent respiratory infection and an early onset of dilated cardiomyopathy, an uncommon feature for MLII. To our knowledge, dilated cardiomyopathy has been previously described in literature in only two cases of MLII and in one patient affected by MLIII.


Assuntos
Cardiomiopatia Dilatada , Diabetes Mellitus Tipo 2 , Mucolipidoses , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/genética , Criança , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Lactente , Mucolipidoses/complicações , Mucolipidoses/diagnóstico , Mucolipidoses/genética , Mutação , Transferases (Outros Grupos de Fosfato Substituídos)/genética
5.
Int Heart J ; 61(5): 1079-1083, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32879264

RESUMO

A Japanese girl with polycystic kidney disease (PKD) developed normally, but at 8 months of age, she was hospitalized for acute onset dyspnea. On the day after admission to hospital, her general condition suddenly became worse. An echocardiogram showed left ventricular dilatation with thin walls, severe mitral valve regurgitation, and a reduced ejection fraction. She died of acute cardiac failure 3 hours after the sudden change. Postmortem analysis with light microscopy showed disarray of cardiomyocytes without obvious infiltration of lymphocytes, and we diagnosed her heart failure as idiopathic dilated cardiomyopathy (DCM). Clinical exome sequencing showed compound heterozygous variants in JPH2 (p.T237A/p.I414L) and a heterozygous nonsense mutation in PKD1 (p.Q4193*). To date, several variants in the JPH2 gene have been reported to be pathogenic for adult-onset hypertrophic cardiomyopathy or DCM in an autosomal dominant manner and infantile-onset DCM in an autosomal recessive manner. Additionally, autosomal dominant polycystic kidney disease is a systemic disease associated with several extrarenal manifestations, such as cardiomyopathy. Here we report a sudden infant death case of DCM and discuss the genetic variants of DCM and PKD.


Assuntos
Cardiomiopatia Dilatada/genética , Proteínas de Membrana/genética , Proteínas Musculares/genética , Rim Policístico Autossômico Dominante/genética , Canais de Cátion TRPP/genética , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/patologia , Morte Súbita Cardíaca/etiologia , Evolução Fatal , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/etiologia , Heterozigoto , Humanos , Lactente , Insuficiência da Valva Mitral/etiologia , Miocárdio/patologia , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue
6.
Am J Cardiol ; 134: 91-98, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32943194

RESUMO

Many patients having orthotopic heart transplantation (OHT) have previously had a left ventricular assist device (LVAD). Such a scenario allows the study of the position of the LVAD cannula in the explanted heart. We studied the explanted hearts in 105 patients who had had a LVAD inserted earlier and later underwent OHT at Baylor University Medical Center from January 2005 to September 2019, and compared the patients in whom the margins of the LVAD cannula contacted the mural endocardium with those in whom it did not. The margins of the orifice of the LVAD cannula contacted the left ventricular (LV) mural endocardium in 38 (36%) patients (considered potentially hazardous insertion) whereas in 67 (64%) patients there was no contact (considered "ideal" insertion). Comparison of the patients with ideal cannular insertion to those with potentially hazardous insertion disclosed insignificant differences in age at LVAD insertion or OHT; gender; interval between the LVAD insertion and OHT; body mass index; underlying cardiac disease; whether or not the heart floated in a container of formaldehyde, and the type of LVAD inserted. The margins of the LVAD cannula contacted the LV mural endocardium significantly more in patients with smaller mean heart weights than those with larger mean heart weights. In conclusion, of the 105 patients studied, the cannula of the LVAD resided in the LV cavity at an angle that allowed the margins of the orifice of the cannula to contact the mural endocardium in 38 (36%), a situation that at least potentially could cause partial obstruction of its orifice. Nevertheless, comparison of the 38 patients with nonideal cannular insertion to the 67 with ideal cannular insertion disclosed only 1 significant difference between the 2 groups.


Assuntos
Cânula , Endocárdio/patologia , Insuficiência Cardíaca/terapia , Transplante de Coração , Ventrículos do Coração/patologia , Coração Auxiliar , Adulto , Idoso , Cardiomiopatia Dilatada/complicações , Feminino , Coração , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Miocárdio/patologia , Tamanho do Órgão , Adulto Jovem
8.
J Clin Pathol ; 73(9): 535-543, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32616540

RESUMO

Dilated cardiomyopathy (DCM) represents a common genetic cause of mechanical and/or electrical dysfunction leading to heart failure (HF) onset for which truncating variants in titin (TTN) gene result in the most frequent mutations. Moreover, myocyte and endothelial cell apoptosis is a key endophenotype underlying cardiac remodelling. Therefore, a deeper knowledge about molecular networks leading to acute injury and apoptosis may reveal novel circulating biomarkers useful to better discriminate HF phenotypes, patients at risk of heart transplant as well as graft reject in order to improve personalised therapy. Remarkably, increased plasma levels of cell-free DNA (cfDNA) may reflect the extent of cellular damage, whereas circulating mitochondrial DNA (mtDNA) may be a promising biomarker of poor prognosis in patients with HF. Furthermore, some panels of circulating miRNAs may improve the stratification of natural history of disease. For example, a combination of miR-558, miR-122* and miR-520d-5p, as well as miR-125a-5p, miR-550a-5p, miR-638 and miR-190a, may aid to discriminate different phenotypes of HF ranging from preserved to reduced ejection fraction. We give update on the most relevant genetic determinants involved in DCM and discuss the putative role of non-invasive biomarkers to overcome current limitations of the reductionist approach in HF management.


Assuntos
Apoptose/genética , Biomarcadores/análise , Cardiomiopatia Dilatada/complicações , MicroRNA Circulante/genética , Epigênese Genética , Insuficiência Cardíaca/genética , Cardiomiopatia Dilatada/genética , Cardiomiopatia Dilatada/fisiopatologia , Ácidos Nucleicos Livres , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Medicina de Precisão
9.
BMC Cardiovasc Disord ; 20(1): 312, 2020 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-32605611

RESUMO

BACKGROUND: An optimal donor work-up to exclude preexisting conditions is recommended, but urgency and technical equipment in donor centers must be considered. We report a case of two coronary stents present in the donor heart and the related long-term outcome. CASE PRESENTATION: A 59-year-old European male patient suffering from dilated cardiomyopathy with severely reduced left ventricular function and presenting with NYHA III underwent cardiac transplantation in 2004. At the one-year follow-up, during routine cardiac catheterization, two stents were found, one in the right coronary artery and one in the circumflex artery, in the patient's transplanted heart. As no stent implantation was performed since transplantation, these were present prior to transplantation and had been transplanted without causing clinical signs. One of the stents showed in-stent restenosis, and the patient received an additional stent 7 years after transplantation. The other stent still showed a good result, and no further intervention has been required so far. The patient is currently in good clinical condition. CONCLUSION: This is the first case report of favorable long-term stented coronary arteries prior to transplantation. This case highlights the importance of the donor work-up and meticulous palpation of the coronary arteries during donor evaluation.


Assuntos
Seleção do Doador , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Intervenção Coronária Percutânea/instrumentação , Stents , Doadores de Tecidos , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/diagnóstico , Cardiomiopatia Dilatada/fisiopatologia , Reestenose Coronária/etiologia , Reestenose Coronária/terapia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Transplante de Coração/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Resultado do Tratamento
10.
J Card Surg ; 35(10): 2866-2868, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32720320

RESUMO

BACKGROUND AND AIMS: Fracture and retention of a guidewire after cardiac resynchronization therapy device implantation has not been reported in the literature so far, although it is an uncommon but known complication during cardiac interventions like percutaneous coronary interventions and other cardiac catheterization procedures. METHODS: A 53 years old female patient presented with severe pain over the left arm and shoulder for a period of 1 to 2 days. The patient had a history of dilated cardiomyopathy with severe left ventricular dysfunction and underwent cardiac resynchronization therapy device implant 3 years back with subsequent lead replacement 6 months back due to lead dysfunction. On evaluation, a coronary guidewire which might have fractured and been retained inadvertently during previous surgical procedure, was discovered in her deltoid muscle. Her symptoms were attributed to the guide wire which may have been aggravated by the movements of her arm. Emergency surgical exploration was done and the guidewire was removed. RESULTS AND CONCLUSION: We are reporting a case of unlikely and unusual delayed presentation of retained intervention guide-wire post cardiac resynchronization therapy, which was retrieved from the left deltoid muscle.


Assuntos
Dispositivos de Terapia de Ressincronização Cardíaca/efeitos adversos , Cardiomiopatia Dilatada/terapia , Músculo Deltoide/cirurgia , Remoção de Dispositivo/métodos , Falha de Equipamento , Intervenção Coronária Percutânea/efeitos adversos , Disfunção Ventricular Esquerda/terapia , Cardiomiopatia Dilatada/complicações , Emergências , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Disfunção Ventricular Esquerda/complicações
12.
Cardiovasc Diabetol ; 19(1): 84, 2020 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-32534593

RESUMO

BACKGROUND: Left ventricular (LV) longitudinal dysfunction has been identified in type 2 diabetes mellitus (T2DM) patients with preserved LV ejection fraction (LVEF). However, the impact of T2DM on LV longitudinal function or the association of LV longitudinal function with outcome for dilated cardiomyopathy (DCM) remains unclear. METHODS: We retrospectively studied 206 patients with non-ischemic DCM, mean age of 59 ± 17 years and LVEF of 31 ± 8% (all < 45%). All patients underwent a standard echocardiographic examination, and LV longitudinal function was assessed in terms of global longitudinal strain (GLS). Long-term outcomes were assessed, with a median follow-up period of 6.2 years, as primary endpoints of death from or hospitalization for deteriorating heart failure. RESULTS: GLS of DCM patients with T2DM (n = 55) was significantly lower than that in DCM patients without T2DM (n = 151) in spite of similar conventional LV function (7.0 ± 2.0% vs. 7.8 ± 2.2%, p = 0.03). Kaplan-Meier curves indicated that long-term outcomes for DCM patients without T2DM were better than for those with T2DM (log-rank p = 0.001). Subdividing the two groups into four with by using the median value of GLS (7.9%) showed long-term outcome was worst for DCM patients with T2DM and low GLS. Cox proportional hazards analyses demonstrated an independent association of T2DM, GLS and left atrial volume index with long-term outcome. Moreover, multiple regression analysis for the association of GLS showed that T2DM was the independent determinant parameter for GLS as well as for LVEF and left atrial volume index. CONCLUSION: Management of DCM patients with T2DM may be improved by using GLS guidance.


Assuntos
Cardiomiopatia Dilatada/complicações , Diabetes Mellitus Tipo 2/complicações , Cardiomiopatias Diabéticas/etiologia , Insuficiência Cardíaca/etiologia , Volume Sistólico , Disfunção Ventricular Esquerda/etiologia , Função Ventricular Esquerda , Adulto , Idoso , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/mortalidade , Cardiomiopatia Dilatada/fisiopatologia , Causas de Morte , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Diabetes Mellitus Tipo 2/fisiopatologia , Cardiomiopatias Diabéticas/diagnóstico por imagem , Cardiomiopatias Diabéticas/mortalidade , Cardiomiopatias Diabéticas/fisiopatologia , Progressão da Doença , Ecocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Hospitalização , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/fisiopatologia
13.
Transpl Infect Dis ; 22(6): e13367, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32533615

RESUMO

The clinical course and outcomes of immunocompromised patients, such as transplant recipients, with COVID-19 remain unclear. It has been postulated that a substantial portion of the disease burden seems to be mediated by the host immune activation to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Herein, we present a simultaneous heart-kidney transplant (SHKT) recipient who was hospitalized for the management of respiratory failure from volume overload complicated by failure to thrive, multiple opportunistic infections, and open non-healing wounds in the setting of worsening renal dysfunction weeks prior to the first case of SARS-CoV-2 being detected in the state of Connecticut. After his third endotracheal intubation, routine nucleic acid testing (NAT) for SARS-CoV-2, in anticipation of a planned tracheostomy, was positive. His hemodynamics, respiratory status, and ventilator requirements remained stable without any worsening for 4 weeks until he had a negative NAT test. It is possible that the immunocompromised status of our patient may have prevented significant immune activation leading up to clinically significant cytokine storm that could have resulted in acute respiratory distress syndrome and multisystem organ failure.


Assuntos
/imunologia , Cardiomiopatia Dilatada/cirurgia , Transplante de Coração , Hospedeiro Imunocomprometido/imunologia , Imunossupressores/uso terapêutico , Falência Renal Crônica/cirurgia , Transplante de Rim , Desnutrição/imunologia , Infecções Oportunistas/imunologia , Antibióticos Antineoplásicos/efeitos adversos , Vírus BK , Bacteriemia/complicações , Bacteriemia/imunologia , Cardiomiopatia Dilatada/induzido quimicamente , Cardiomiopatia Dilatada/complicações , Cardiotoxicidade , Doxorrubicina/efeitos adversos , Rejeição de Enxerto/prevenção & controle , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/imunologia , Humanos , Achados Incidentais , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Desnutrição/complicações , Staphylococcus aureus Resistente à Meticilina , Pessoa de Meia-Idade , Ácido Micofenólico/uso terapêutico , Infecções Oportunistas/complicações , Infecções por Polyomavirus/complicações , Infecções por Polyomavirus/imunologia , Complicações Pós-Operatórias/terapia , Prednisona/uso terapêutico , Diálise Renal , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/imunologia , Infecção da Ferida Cirúrgica/complicações , Infecção da Ferida Cirúrgica/imunologia , Tacrolimo/uso terapêutico , Traqueostomia , Infecções Tumorais por Vírus/complicações , Infecções Tumorais por Vírus/imunologia , Enterococos Resistentes à Vancomicina , Viremia/complicações , Viremia/imunologia , Desequilíbrio Hidroeletrolítico/complicações , Desequilíbrio Hidroeletrolítico/terapia
14.
Transpl Infect Dis ; 22(6): e13380, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32573990

RESUMO

A heart transplant 62-year-old patient referred for coronavirus-19 disease (COVID-19) pneumonia. At admission, he was febrile, tachypnoeic, and mild hypoxic with dry cough; during hospitalization, a diffuse morbilliform skin rash appeared. He was treated with tocilizumab with symptoms improvement, without a complete pulmonary function recovery. Skin rash, highly suggestive for COVID-19 cutaneous involvement, persisted for ten days despite tocilizumab administration.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Transplante de Coração , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , /fisiopatologia , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/cirurgia , Tosse/fisiopatologia , Diarreia/fisiopatologia , Enoxaparina/uso terapêutico , Inibidores Enzimáticos/uso terapêutico , Exantema/fisiopatologia , Febre/fisiopatologia , Glucocorticoides/uso terapêutico , Humanos , Hidroxicloroquina/uso terapêutico , Hipóxia/fisiopatologia , Hospedeiro Imunocomprometido/imunologia , Imunossupressores/uso terapêutico , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Náusea/fisiopatologia , Combinação Piperacilina e Tazobactam/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/complicações , Insuficiência Renal Crônica/complicações , Taquipneia/fisiopatologia , Resultado do Tratamento
16.
J Cardiothorac Surg ; 15(1): 123, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493377

RESUMO

BACKGROUND: Heart failure complicated by pulmonary embolism is an extremely rare condition described in the literature. We report a case of very young patient with advanced heart failure against the background of dilated cardiomyopathy of unknown etiology with the presence of blood clots in both ventricles. CASE PRESENTATION: The course of treatment was complicated by acute pulmonary embolism. In emergency setting the patient was qualified for combine surgery pulmonary embolization and implantation of a continuous flow pump as a bridge for heart transplantation. The post-operative course is described in detail as well as reimplantation of the pump due to early thrombosis. CONCLUSIONS: Performed surgical procedures combined with alteration in anticoagulant drugs was sufficient to stabilize the clinical condition.


Assuntos
Anticoagulantes/uso terapêutico , Cardiomiopatia Dilatada/terapia , Embolectomia/métodos , Insuficiência Cardíaca/terapia , Coração Auxiliar , Embolia Pulmonar/terapia , Trombectomia/métodos , Trombose/terapia , Adolescente , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/diagnóstico por imagem , Ecocardiografia , Cardiopatias/complicações , Cardiopatias/terapia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico por imagem , Transplante de Coração , Ventrículos do Coração , Humanos , Masculino , Implantação de Prótese , Artéria Pulmonar , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico por imagem , Trombose/complicações
17.
Am J Cardiol ; 129: 42-45, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32540168

RESUMO

Studies have shown that highly selected patients who underwent combined heart-kidney (HK) and heart-liver transplants (HLv) have short- and long-term outcomes comparable to those observed in primary heart transplantation (HT). Adults patients with stage D heart failure that underwent combined HK, HLv, and heart-lung (HL) were identified in the United Network for Organ Sharing registry from 1991 to 2016, with follow-up through March 2018. We conducted inverse probability of treatment weighting survival analysis of long-term survival stratified by type of combined organ transplant, accounting for donor, recipient, and operative characteristics. We identified 2,300 patients who underwent combined organ transplant (HK 1,257, HLv 212, HL 831). HL recipients were more likely white (77%), women (58%), with congenital heart disease (44.5%), and longer waiting list time (median 195 days). HK transplant increased significantly during the study period where as HL decreased significantly. Median survival was 12.2 years for HK (95% confidence intervals [CI] 10.8 to 12.8), 12 for HLv (95% CI 8.6 to 17.6) but significantly lower at 4.5 years for HL (95% CI 3.6 to 5.8). Combined HK and HLv transplantation rates are increasing and long-term survival is comparable to primary HT, unlike HL which is associated with decreasing trends and significantly lower survival.


Assuntos
Insuficiência Cardíaca/cirurgia , Transplante de Coração , Transplante de Rim , Transplante de Fígado , Mortalidade , Adulto , Afro-Americanos , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Restritiva/complicações , Grupo com Ancestrais do Continente Europeu , Feminino , Rejeição de Enxerto , Cardiopatias Congênitas/complicações , Insuficiência Cardíaca/complicações , Transplante de Coração-Pulmão , Hispano-Americanos , Humanos , Nefropatias/complicações , Nefropatias/cirurgia , Hepatopatias/complicações , Hepatopatias/cirurgia , Pneumopatias/complicações , Pneumopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Sistema de Registros , Reoperação , Taxa de Sobrevida
18.
Klin Lab Diagn ; 65(4): 222-227, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32227727

RESUMO

The aim of research was to evaluate the impact of erythrocytoses on processes of cardiovascular system's remodelling in patients with dilated and ishaemic cardiomyopathies. 35 (42,2%) patients with dilated cardiomyopathy (DCMP) with erythrocytoses, 19 (23,5%) without erythrocytosis, 34 (28,4%) patients with ishaemic cardiomyopathy (ICMP) with erythrocytosis and 50 (60,1%) without erythrocytosis were included in the study. It has been established that erythrocytoses don't wield major influence on the heart's haemodynamics, they appear as a consequence of main diseases and not as their reason, which confirms the domination of congestive heart failure's signs of III-IV stages. In patients with DCMP and ICMP signs of tissue hypoxia were established as well as oxygen reduction in arterial blood to 60,70 ± 1,24 mm Hg in cases of DCMP and 59,60 ± 1,24 mm Hg in cases of ICMP (in verification 75,44 ± 0,93) - p < 0,001. Arguably, erythrocytoses in cases of DCMP and ICMP are a consequence of congestive heart failure, leading to hypoxic erythrocytosis.


Assuntos
Cardiomiopatia Dilatada/complicações , Insuficiência Cardíaca/complicações , Isquemia Miocárdica/complicações , Policitemia/complicações , Humanos , Hipóxia
19.
Medicine (Baltimore) ; 99(17): e19874, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332655

RESUMO

INTRODUCTION: Heart transplantation (HT) is known to be the final therapy for patients with advanced heart failure; however, the exercise capacity of these patients remains under the aged-predicted value after HT. Many studies have described the effectiveness and safety of cardiac rehabilitation (CR) in HT recipients. Nevertheless, long-term follow-up data of HT recipients undergoing CR are insufficient, and there is a lack of evidence on the long-term effects of CR. In this case report, we present the long-term benefits of CR in an HT recipient, including serial follow-up clinical data over 1 year. PATIENT CONCERNS: A 48-year-old female patient underwent HT because of advanced dilated cardiomyopathy. DIAGNOSIS: Cardiopulmonary exercise test showed reduced exercise capacity and pulmonary function. The grip power and quadriceps muscle strength were also decreased after HT. INTERVENTIONS: The patient underwent a phase I CR program for 3 months, followed by a phase III CR program for 7 months. In the beginning, moderate-intensity continuous training was conducted. Thereafter, high-intensity interval training was implemented after a period of adjustment for interval training. OUTCOMES: The exercise capacity, 6-min walk distance, muscle strength, and vital capacity were improved after CR. CONCLUSION: CR in HT recipients may improve muscle strength and pulmonary function as well as exercise capacity, without serious cardiovascular complications. Phase III CR may help maintain exercise capacity in these patients.


Assuntos
Assistência ao Convalescente/métodos , Reabilitação Cardíaca/normas , Transplante de Coração/reabilitação , Resultado do Tratamento , Reabilitação Cardíaca/métodos , Reabilitação Cardíaca/tendências , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/fisiopatologia , Cardiomiopatia Dilatada/cirurgia , Terapia por Exercício/métodos , Tolerância ao Exercício , Feminino , Transplante de Coração/psicologia , Transplante de Coração/normas , Humanos , Pessoa de Meia-Idade
20.
Am J Transplant ; 20(7): 1911-1915, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32315122

RESUMO

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is rapidly infecting people worldwide, resulting in the infectious disease coronavirus disease 19 (COVID-19) that has been declared a pandemic. Much remains unknown about COVID-19, including its effects on solid organ transplant (SOT) recipients. Given their immunosuppressed state, SOT recipients are presumed to be at high risk of complications with viral infections such as SARS-CoV-2. Limited case reports in single SOT recipients, however, have not suggested a particularly severe course in this population. In this report, we present a dual-organ (heart/kidney) transplant recipient who was found to have COVID-19 and, despite the presence of a number of risk factors for poor outcomes, had a relatively mild clinical course.


Assuntos
Cardiomiopatia Dilatada/complicações , Infecções por Coronavirus/diagnóstico , Transplante de Coração , Falência Renal Crônica/complicações , Transplante de Rim , Pneumonia Viral/diagnóstico , Monofosfato de Adenosina/administração & dosagem , Monofosfato de Adenosina/análogos & derivados , Adulto , Alanina/administração & dosagem , Alanina/análogos & derivados , Betacoronavirus , Cardiomiopatia Dilatada/cirurgia , Infecções por Coronavirus/complicações , Humanos , Hidroxicloroquina/administração & dosagem , Hospedeiro Imunocomprometido , Imunossupressão/efeitos adversos , Imunossupressores/efeitos adversos , Falência Renal Crônica/cirurgia , Masculino , Pandemias , Pneumonia Viral/complicações , Radiografia Torácica , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Resultado do Tratamento
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