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2.
J Thorac Cardiovasc Surg ; 159(3): 865-896, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31983522
3.
Acta Odontol Scand ; 78(1): 20-25, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31661343

RESUMO

Objective: The aim of this study was to compare the periodontal status and dental behaviour of heart transplant recipients with systemically healthy controls.Material and Methods: Forty heart transplant recipients and 40 systemically healthy patients were included. A questionnaire was used to record demographic, systemic health and dental behaviour data, and the following clinical parameters were recorded: plaque index, bleeding on probing, probing depth, gingival recession, and clinical attachment level.Results: Mean probing depth (p = .045), mean gingival recession (p = .016), mean clinical attachment level (p = .021) and mean plaque index scores (p = .001) were higher in heart transplant recipients than the systemically healthy group. However, bleeding on probing was similar in both groups (p > .05). Tooth brushing frequency and number of participants who used dental floss/interdental brush was lower in the heart transplant group.Conclusion: Considering the poor oral hygiene and high clinical periodontal parameters of heart transplant recipients, periodontal evaluation should be done regularly before and after transplantation. The patient's daily oral hygiene regimens should be evaluated carefully in this evaluation session and modified based on their gingival health, manual skill and motivational levels. The importance of oral health and its effects on systemic health should also be explained to the transplant recipients in detail.


Assuntos
Placa Dentária , Transplante de Coração , Saúde Bucal , Higiene Bucal , Doenças Periodontais/epidemiologia , Adolescente , Adulto , Estudos de Casos e Controles , Placa Dentária/epidemiologia , Placa Dentária/etiologia , Índice de Placa Dentária , Feminino , Transplante de Coração/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Periodontais/etiologia , Índice Periodontal , Adulto Jovem
4.
J Surg Res ; 246: 207-212, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31605947

RESUMO

BACKGROUND: The use of left ventricular assist devices (LVADs) as a bridge to heart transplantation has increased rapidly over the last 2 decades. We aim to explore the effect of pretransplant systemic and device-related complications on posttransplant survival for patients bridged with LVADs. MATERIALS AND METHODS: The United Network of Organ Sharing (Organ Procurement and Transplantation Network) database was queried for all adult heart transplant recipients (aged ≥ 18 y) transplanted from April 1, 2015, to June 31, 2018. Device-related complications included thrombosis, device infection, device malfunction, life-threatening arrhythmia, and other device complications. Systemic complications included a new dialysis need or ventilator dependence between the time of listing and transplantation, transfusion, or systemic infection requiring treatment with intravenous antibiotics within 2 wk of transplantation. RESULTS: A total of 2131 patients were identified as requiring LVAD support before transplantation. LVAD patients had high rates of preoperative systemic complications (53%) and high rates of device-related complications (42.7% experienced at least one device-related complication). Kaplan-Meier analysis revealed a significantly decreased 1-y survival for LVAD patients bridged to transplantation who experienced a pretransplant systemic complication (P = 0.041). Interestingly, preoperative device-related complications had no effect on 1-y posttransplantation survival (P = 0.93). Multivariate Cox modeling revealed that systemic complications were associated with a significantly increased risk of posttransplant mortality for LVAD patients (hazard ratio 1.45; P = 0.033). CONCLUSIONS: Recipients who suffered a systemic complication while awaiting heart transplantation experienced higher short-term mortality rates. Device-related complications do not appear to impact posttransplantation outcomes.


Assuntos
Insuficiência Cardíaca/cirurgia , Transplante de Coração/efeitos adversos , Coração Auxiliar/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Diálise Renal/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Listas de Espera/mortalidade
7.
Clin Hemorheol Microcirc ; 73(1): 19-27, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31561344

RESUMO

Hyperlipidemic heart transplant patients who develop cardiac allograft vasculopathy (CAV) benefit from HELP-apheresis (Heparin-induced Extracorporeal LDL Precipitation) which enables drastic lowering of plasma low-density lipoprotein, lipoprotein (a), and fibrinogen. There is evidence that HELP-apheresis also improves microcirculation by an immediate improvement of impaired endothelial-dependent vasodilatation and additive hemorheological effects.Therefore, cutaneous microcirculation was examined before, during, and after the first HELP-apheresis in eight hyperlipidemic cardiac transplant recipients with CAV. To study the long-term effect the intravital microscopy was repeated after three and 12 months of weekly apheresis treatment.In CAV patients the baseline mean erythrocyte velocity was pathologically reduced with 0.13±0.07 mm/s. During the first HELP-apheresis the erythrocyte velocity increased significantly (p = 0.0001) and remained increased until the end of the HELP procedure (p < 0.05). After three months of weekly apheresis treatment a decrease of temporary flow stops in the capillaries with a progressive homogenization (concordance) of the cutaneous microcirculation was observed. After one year of weekly treatment a markedly increase in mean erythrocyte velocity under resting conditions occurred. In addition, a reactive post-ischemic hyperemia could be established for the first time.Even the first single HELP-apheresis resulted in a significant improvement of the cutaneous microcirculation. The long-term treatment of these patients resulted in a marked improvement of the cutaneous microcirculation with the tendency to a normalization of the regulation of the capillary perfusion.


Assuntos
Remoção de Componentes Sanguíneos/métodos , Transplante de Coração/efeitos adversos , Transplante de Coração/métodos , Heparina/uso terapêutico , Hipercolesterolemia/tratamento farmacológico , Lipoproteínas LDL/sangue , Microcirculação/fisiologia , Aloenxertos , Feminino , Heparina/farmacologia , Humanos , Hipercolesterolemia/sangue , Masculino , Pessoa de Meia-Idade
8.
Transplant Proc ; 51(8): 2808-2813, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31563248

RESUMO

INTRODUCTION: Prostaglandin E1 (PGE1) administered to patients in the immediate post-transplant period has been known to reduce ischemic reperfusion injuries (IRIs), but the effect on IRI of PGE1 administered to the donor is unknown. The purpose of this study was to determine the effect on IRI of PGE1 injected into donor rats during heterotopic heart transplantation. METHODS: Genetically identical male Sprague Dawley rats with a body weight of 300-320 g at 8-9 weeks of age were used for the study. Experimental methods were the same in the control (G0, n = 6) and experimental groups (G1, n = 6), but only the donor rats in the experimental group received an intramuscular injection of PGE1 (5 µg/kg) prior to the donor surgery. On day 1 the animals were sacrificed with the removal of the transplanted heart. Histologic analysis was performed in the hematoxylin-eosin-stained slides to assess interstitial edema and neutrophil infiltration by a pathologist. RESULTS: Median times of the donor organ procurement, cold ischemia, and warm ischemia were 37, 69, and 35 minutes, respectively, in the G0 group and 38, 76.5, and 33 minutes respectively in G1 group; there were no statistical differences. Heartbeats were observed in the transplanted graft in 2 of the G0 group and 2 of G1 group immediately after heart transplantation, but in all transplanted grafts on day 1 after surgery. Histologic scores for neutrophil infiltration showed significantly lower in the G1 group than in the G0 group. CONCLUSION: PGE1 administration to donors in a rat heart transplantation model may significantly reduce IRI.


Assuntos
Alprostadil/uso terapêutico , Transplante de Coração/efeitos adversos , Traumatismo por Reperfusão/prevenção & controle , Vasodilatadores/uso terapêutico , Alprostadil/administração & dosagem , Animais , Masculino , Ratos , Ratos Sprague-Dawley , Traumatismo por Reperfusão/etiologia , Doadores de Tecidos , Transplante Heterotópico , Vasodilatadores/administração & dosagem
9.
Pediatr Cardiol ; 40(8): 1655-1662, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31506731

RESUMO

We sought to better define the demographics and characteristics of post-transplant lymphoproliferative disorders (PTLD) in a cohort of paediatric OHT patients from a developing country. Data were collected from the Heart Institute, Sao Paulo, for all paediatric OHT recipients from October 1992 to October 2018. Group differences between the PTLD and non-PTLD cohorts were assessed by Fisher exact and Mann-Whitney U tests. Kaplan-Meier curves analysed the survival in each group. Data were reviewed for 202 paediatric OHT recipients. Overall 1-, 5- and 10-year survival for the entire cohort was 76.5%, 68.3% and 62.9%; 24 patients (11.9%) developed PTLD at a median 3.1 years (IQR 0.8-9.0) after OHT. Cases were evenly spread over the follow-up period, with PTLD diagnosed in 9.8% (n = 137) of patients who were alive at 3 years, 15.3% (n = 78) of patients who were alive at 5 years and 29.3% (n = 41) of patients who were alive at 10 years. The commonest form of PTLD was diffuse large B cell lymphoma (n = 9), and most patients received rituximab with immunosuppression and chemotherapy as treatment (n = 15). We identified no increased risk in mortality amongst the PTLD vs. non-PTLD cohorts in multivariate analysis (P = 0.365). PTLD after paediatric OHT had acceptable outcomes. However, risk factors for PTLD were not identified and warrant further investigation.


Assuntos
Transplante de Coração/efeitos adversos , Transtornos Linfoproliferativos/mortalidade , Brasil , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Transplante de Coração/mortalidade , Humanos , Lactente , Transtornos Linfoproliferativos/diagnóstico , Transtornos Linfoproliferativos/etiologia , Masculino , Prevalência , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida
11.
Rev Port Cardiol ; 38(7): 497-501, 2019 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31495716

RESUMO

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 X
12.
Int Heart J ; 60(5): 1222-1225, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484879

RESUMO

Bradycardia is a common complication at the early postoperative period after heart transplantation (HT). The heart rate (HR) usually recovers within a few weeks; however, several patients need a temporary pacemaker or chronotropic agents to stabilize their hemodynamics. Here, we report the first case of transient bradycardia associated with hemodynamic deterioration following HT, which was successfully treated with cilostazol, a phosphodiesterase-3-inhibiting agent. A 59-year-old man received HT for advanced heart failure due to ischemic cardiomyopathy. General fatigue persisted even after the HT. His HR was around 60 beats per minute (bpm) with sinus rhythm. Echocardiography showed no abnormal findings. Right heart catheterization showed that the cardiac index (CI) was 1.9 L/minute/m2. Continuous intravenous infusion of isoproterenol (0.003 µg/kg/minute) increased the HR to 80 bpm and CI to 2.7 L/minute/m2 and improved his symptoms. Isoproterenol was switched to oral administration of cilostazol (100 mg, twice a day), which maintained the HR at around 80 bpm and CI of 2.5 L/minute/m2. The patient's HR gradually recovered and cilostazol could be discontinued three months after the HT. Oral administration of cilostazol can be a therapeutic option for patients with sinus bradycardia following HT, who need positive chronotropic support.


Assuntos
Bradicardia/tratamento farmacológico , Cilostazol/uso terapêutico , Insuficiência Cardíaca/cirurgia , Transplante de Coração/efeitos adversos , Bradicardia/diagnóstico por imagem , Bradicardia/etiologia , Débito Cardíaco/efeitos dos fármacos , Eletrocardiografia/métodos , Seguimentos , Insuficiência Cardíaca/diagnóstico , Transplante de Coração/métodos , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/etiologia , Edema Pulmonar/fisiopatologia , Radiografia Torácica/métodos , Fatores de Tempo , Resultado do Tratamento
13.
Transpl Infect Dis ; 21(5): e13163, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31472083

RESUMO

We report three cases of hospital-acquired mucormycosis in heart and lung transplant patients over a 6-month period. Traditional epidemiological investigation tools were used to look for a common link between patients to explain the outbreak. Genome sequencing of each fungal strain was used to supplement the investigation. By disproving a close genetic link between infecting strains of mucormycosis, we were able to conclude the outbreak investigation. Genome sequencing is a novel tool that can be used in addition to traditional epidemiologic investigations to help determine linkage of patients during outbreak investigations.


Assuntos
Infecção Hospitalar/microbiologia , Surtos de Doenças/estatística & dados numéricos , Genoma Fúngico , Mucorales/genética , Mucormicose/microbiologia , Transplantados , Idoso , DNA Fúngico/genética , Transplante de Coração/efeitos adversos , Humanos , Transplante de Pulmão/efeitos adversos , Masculino , Pessoa de Meia-Idade , Mucorales/classificação , Mucormicose/diagnóstico , Análise de Sequência de DNA
14.
Ann Transplant ; 24: 454-460, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31383839

RESUMO

BACKGROUND The appearance of human leukocyte antigen (HLA) antibodies after solid organ transplantation predisposes recipients to graft dysfunction. In theory, vascular homografts, which are widely used in children with congenital heart defects, may cause allosensitization. MATERIAL AND METHODS In this single-center retrospective study, the presence of pre-existing HLA antibodies in pediatric heart transplant (HTx) recipients with a vascular homograft was evaluated in a cohort of 12 patients. HLA antibodies were screened before and after HTx and positive screening results were confirmed and identified using the Luminex® single antigen bead method. Endomyocardial biopsies (EMB) and coronary angiography studies were re-evaluated to assess the prevalence of acute rejections and coronary artery change in these patients. RESULTS At the time of HTx, 8 patients (67%) had HLA antibodies detected by the Luminex assay, none of which were heart donor specific (DSA). All patients had negative leukocyte crossmatch. One patient developed DSAs against homograft donor prior to HTx. After the HTx, 5 patients (42%) developed DSAs against the heart donor and 4 patients (40%) against the homograft donor. In 2 patients (17%), the antibodies were against both heart and homograft donors. The rejection rate or prevalence of coronary artery vasculopathy did not differ significantly between the homograft cohort and our historical controls. CONCLUSIONS Our results suggest that the prevalence of DSAs against homograft donor prior to HTx is relatively rare. However, almost half of the patients developed DSAs against homograft post-HTx. The clinical importance of these antibodies warrants further studies.


Assuntos
Antígenos HLA/imunologia , Transplante de Coração/efeitos adversos , Isoanticorpos/imunologia , Adolescente , Criança , Pré-Escolar , Feminino , Rejeição de Enxerto/imunologia , Sobrevivência de Enxerto , Humanos , Lactente , Masculino , Estudos Retrospectivos
15.
Methodist Debakey Cardiovasc J ; 15(2): 145-148, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384378

RESUMO

Steady advances in the diagnosis and management of congenital heart disease over the last few decades has resulted in a growing population of adults with congenital heart disease (ACHD). Consequently, there has been a parallel increase in the number of ACHD patients plagued with end-stage heart failure. Even so, the transplantation rate for these patients has remained low, at about 3% of all adult heart transplants. This review discusses the scope of transplantation for ACHD, including indications and contraindications, specific challenges and nuances, and post-transplant outcomes.


Assuntos
Cardiopatias Congênitas/cirurgia , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Adulto , Fatores Etários , Tomada de Decisão Clínica , Progressão da Doença , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/fisiopatologia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Transplante de Coração/efeitos adversos , Transplante de Coração/mortalidade , Humanos , Seleção de Pacientes , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Listas de Espera
16.
J Cardiothorac Surg ; 14(1): 153, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438988

RESUMO

BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been used increasingly to support patients with cardiogenic shock (CS). There has been growing recognition of the favorable and unfavorable hemodynamic effects of this therapy and recent interest in the use of other percutaneous circulatory support devices to offset some of the potentially harmful hemodynamic effects. Herein, we provide visual evidence of the effects of intra-aortic balloon pump (IABP) counterpulsation for a patient with peripheral VA-ECMO cannulation. CASE PRESENTATION: A 68 year old man who had undergone orthotopic heart transplantation presented with 2 days of fatigue, orthopnea, and paroxysmal nocturnal dyspnea. On examination, he was tachycardic, hypotensive and hypoxic with cool extremities, consistent with CS. Transthoracic echocardiogram (TTE) showed new severe biventricular dysfunction with a left ventricular ejection fraction of 15%, right heart catheterization demonstrated elevated filling pressures and low output. An IABP was inserted via the left femoral artery with minimal improvement in hemodynamics. He was escalated to VA-ECMO. Repeat TTE demonstrated aortic valve (AV) opening with each cardiac cycle and mild MR. With placement of the IABP on standby Additional file 1: Video 1 (video 0:03), the AV no longer opened. Re-initiation of balloon counterpulsation resulted in resumed AV opening with each beat Additional file 1: Video 1 (video 0:17). He was treated for presumed acute allograft rejection with methylprednisolone, thymoglobulin, intravenous immunoglobulin and plasmapheresis with improvement in allograft function. However, he developed an Enterobacter aerogenes pneumonia and rapidly fatal septic shock. CONCLUSIONS: This case visually demonstrates effective LV decompression by IABP counterpulsation in VA-ECMO support. While the overall effects of LV decompression in patients on VA-ECMO with IABP are still unclear, this report demonstrates one potential mechanism of benefit in the prevention of stagnation of blood flow that may lead to intra-cardiac or aortic root thrombus formation.


Assuntos
Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/métodos , Balão Intra-Aórtico , Choque Cardiogênico/terapia , Idoso , Descompressão Cirúrgica , Evolução Fatal , Transplante de Coração/efeitos adversos , Ventrículos do Coração/cirurgia , Hemodinâmica , Humanos , Masculino , Choque Cardiogênico/etiologia , Função Ventricular Esquerda/fisiologia
17.
Eur J Appl Physiol ; 119(10): 2225-2236, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31407088

RESUMO

PURPOSE: Heart transplantation causes denervation of the donor heart, but the consequences for cardiovascular homeostasis remain to be fully understood. The present study investigated cardiovascular autonomic control at supine rest, during orthostatic challenge and during isometric exercise in heart transplant recipients (HTxR). METHODS: A total of 50 HTxRs were investigated 7-12 weeks after transplant surgery and compared with 50 healthy control subjects. Continuous, noninvasive recordings of cardiovascular variables were carried out at supine rest, during 15 min of 60° head-up tilt and during 1 min of 30% of maximal voluntary handgrip. Plasma and urine catecholamines were assayed, and symptoms were charted. RESULTS: At supine rest, heart rate, blood pressures and total peripheral resistance were higher, and stroke volume and end diastolic volume were lower in the HTxR group. During tilt, heart rate, blood pressures and total peripheral resistance increased less, and stroke volume and end diastolic volume decreased less. During handgrip, heart rate and cardiac output increased less, and stroke volume and end diastolic volume decreased less. Orthostatic symptoms were similar across the groups, but the HTxRs complained more of pale and cold hands. CONCLUSION: HTxRs are characterized by elevated blood pressures and total peripheral resistance at supine rest as well as attenuated blood pressures and total peripheral resistance responses during orthostatic challenge, possibly caused by low-pressure cardiopulmonary baroreceptor denervation. In addition, HTxRs show attenuated cardiac output response during isometric exercise due to efferent sympathetic denervation. These physiological limitations might have negative functional consequences.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Exercício , Transplante de Coração/efeitos adversos , Intolerância Ortostática/epidemiologia , Transplantados , Adolescente , Adulto , Idoso , Pressão Sanguínea , Catecolaminas/sangue , Catecolaminas/urina , Feminino , Força da Mão , Coração/fisiopatologia , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Intolerância Ortostática/fisiopatologia
18.
Pediatr Cardiol ; 40(8): 1756-1758, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31367951

RESUMO

The evaluation of oncologic patients at risk of chemotherapy-induced cardiotoxicity usually focuses on left ventricular function. However, recent studies have demonstrated that right ventricle impairment often coexists (and in some cases precedes) left-side affectation. We present the case of a 19-year-old heart transplant recipient who developed severe right ventricular dysfunction secondary to treatment of an abdominal lymphoma.


Assuntos
Antibióticos Antineoplásicos/efeitos adversos , Doxorrubicina/efeitos adversos , Linfoma de Células B/tratamento farmacológico , Disfunção Ventricular Direita/etiologia , Função Ventricular Direita/efeitos dos fármacos , Cardiotoxicidade/etiologia , Ecocardiografia , Feminino , Transplante de Coração/efeitos adversos , Humanos , Transplantados , Disfunção Ventricular Direita/fisiopatologia , Adulto Jovem
19.
Cardiol Young ; 29(9): 1219-1221, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31451126

RESUMO

Aortic dissection causes significant morbidity and mortality in adults and treatment guidelines are based on well-documented risk factors. Conversely, dissection after orthotopic heart transplantation is very rare, especially in the absence of infection, hypertension, or donor-recipient aortic size mismatch. Several forms of CHD are associated with aortic dilatation, but the incidence of aortic dissection and aneurysm in children is also low, which makes use of adult guidelines in children challenging. We present a 17-year-old Amish female with a homozygous gene mutation in the MYBPC3 gene known to cause lethal, infantile hypertrophic cardiomyopathy. She underwent orthotopic heart transplantation and then developed an asymptomatic aortic dissection despite no known risk factors.


Assuntos
Aneurisma Dissecante/diagnóstico , Aneurisma da Aorta Torácica/diagnóstico , Transplante de Coração/efeitos adversos , Complicações Pós-Operatórias , Transplantados , Adolescente , Angiografia por Tomografia Computadorizada , Feminino , Insuficiência Cardíaca/cirurgia , Humanos , Achados Incidentais
20.
Medicina (Kaunas) ; 55(7)2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31315301

RESUMO

Objectives: Many studies indicate the involvement of transient receptor potential (TRP) channels in the development of heart hypertrophy. However, the data is often conflicted and has originated in animal models. Here, we provide systematic analysis of TRP channels expression in human failing myocardium. Methods and results: Left-ventricular tissue samples were isolated from explanted hearts of NYHA III-IV patients undergoing heart transplants (n = 43). Quantitative real-time PCR was performed to assess the mRNA levels of TRPC, TRPM and TRPV channels. Analysis of functional, clinical and biochemical data was used to confirm an end-stage heart failure diagnosis. Compared to myocardium samples from healthy donor hearts (n = 5), we detected a distinct increase in the expression of TRPC1, TRPC5, TRPM4 and TRPM7, and decreased expression of TRPC4 and TRPV2. These changes were not dependent on gender, clinical or biochemical parameters, nor functional parameters of the heart. We detected, however, a significant correlation of TRPC1 and MEF2c expression. Conclusions: The end-stage heart failure displays distinct expressional changes of TRP channels. Our findings provide a systematic description of TRP channel expression in human heart failure. The results highlight the complex interplay between TRP channels and the need for deeper analysis of early stages of hypertrophy and heart failure development.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Transplante de Coração/efeitos adversos , Canais de Receptores Transientes de Potencial/análise , Análise de Variância , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/complicações , Transplante de Coração/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Proteínas Serina-Treonina Quinases/análise , Proteínas Serina-Treonina Quinases/sangue , Reação em Cadeia da Polimerase em Tempo Real/métodos , Estatísticas não Paramétricas , Canais de Cátion TRPC/análise , Canais de Cátion TRPC/sangue , Canais de Cátion TRPM/análise , Canais de Cátion TRPM/sangue , Canais de Receptores Transientes de Potencial/sangue , Canais de Receptores Transientes de Potencial/farmacologia
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