Dispositivos de asistencia ventricular como tratamiento de destino. A propósito de un caso.

The treatment of refractory terminal heart failure has been heart transplantation. However, there are limitations with regard to clinical conditions of the recipient and availability of donors, and ventricular support has therefore been alternatively used as destination therapy. We describe the case is of a female patient with ischemic cardiomyopathy-associated heart failure who had a left ventricular assist device successfully implanted and at eight months of the procedure was at functional class I, with no complications.

El tratamiento de la falla cardiaca terminal avanzada ha sido el trasplante de corazón, sin embargo, hay limitantes en cuanto a las características del receptor y disponibilidad de donadores, por lo que se ha utilizado alternativamente el soporte ventricular como tratamiento de destino. Se describe a una paciente con falla cardiaca terminal por cardiomiopatía isquémica en quien se implantó exitosamente un sistema de soporte ventricular izquierdo y a ocho meses del procedimiento se encontraba en clase funcional I, sin complicaciones.

[Retrasplante cardiaco electivo. Primer caso en México].

Orthotopic cardiac retransplantation is used to treat transplanted cardiac graft end-stage failure. We present the first case of successful elective cardiac retransplantation in Mexico. It was a 25-year old male with heart transplantation who developed graft-resistant chronic vasculopathy. He underwent elective retransplantation in September 2017; complications during postoperative evolution were treated with favorable response. He was discharged owing to improvement at four weeks postoperatively. It is concluded that in adequately selected cases and comprehensively assessed, cardiac retransplantation is an appropriate option to treat cardiac graft failure.

El retrasplante cardiaco ortotópico se utiliza para tratar la falla cardiaca terminal del injerto cardiaco trasplantado. Presentamos el primer caso exitoso de retrasplante cardiaco electivo en México. Se trató de un varón de 25 años con trasplante de corazón, quien presentó vasculopatía crónica resistente del injerto. Fue retrasplantado electivamente en septiembre de 2017; las complicaciones durante la evolución posoperatoria fueron tratadas con respuesta favorable. Egresó por mejoría a las cuatro semanas del posoperatorio. Se concluye que en los casos apropiadamente seleccionados y valorados integralmente, el retrasplante cardiaco es una opción adecuada para el manejo de la falla cardiaca del injerto.

[Combined heart-kidney transplantation in Mexic]. / Trasplante combinado de corazón-riñón en México.

BACKGROUND: In our country, heart and kidney transplantation is a novel option for treatment of combined terminal heart and kidney failure. This program began in 2012 for selected patients with documented terminal heart failure and structural kidney damage with renal failure. Description of cases: Between January 1, 2012 and April 30, 2016, we made 92 orthotopic heart transplantations. In five of these cases the heart transplantation was combined with kidney transplantation. RESULTS: There were three male and two female patients with a mean age 25.6 ± 5.2 years (range, 17-29). The patients improved their renal function and the heart transplantation was successful with an improved quality of life. One patient died from abdominal sepsis. The other patients are doing well. CONCLUSION: The combined heart-kidney transplantation is a safe and efficient procedure for patients with structural kidney and heart damage as a cause of terminal failure.

[Mucha-Habermann disease and orthotopic heart transplant. Case report]. / Enfermedad de Mucha-Habermann y trasplante ortotópico de corazón. Informe de un caso clínico.

BACKGROUND: Mucha-Habermann disease is a cutaneous clinical manifestation of unknown etiology that frequently appears in young patients. The aim was to present Mucha-Habermann disease that occurred in an old man who had a heart transplant. CLINICAL CASE: a 62 year-old male, heart transplant recipient, who four years after that transplantation procedure presented with papular lesions in neck, thoracic members of which extended to all body surfaces and that evolved vesicles and pustular lesions. A skin biopsy was performed and Mucha-Habermann disease was diagnosed. The patient was treated with steroids and antimicrobial therapy with favorable response. After two years there are no skin lesions. CONCLUSIONS: Mucha-Habermann disease is a low frequency disease and it requires skin biopsy to confirm diagnose. This is an uncommon case due to the age and kind of patient.

Introducción: la enfermedad de Mucha-Habermann es la afección cutánea de etiología desconocida más frecuente en los pacientes jóvenes. Se caracteriza por la erupción aguda de lesiones papulares que evolucionan a vesículas, pústulas y cicatrices deprimidas hiperpigmentadas de aspecto varioliforme. Su curso habitual es subagudo o crónico. El objetivo es describir la enfermedad de Mucha-Habermann en un hombre con trasplante ortotópico de corazón. Caso clínico: hombre de 62 años de edad que cuatro años después de recibir trasplante de corazón presentó lesiones papulares diseminadas en cuello y miembros torácicos, las cuales se extendieron al resto del cuerpo y evolucionaron a vesículas y pústulas. Se obtuvo biopsia de piel y se conformó el diagnóstico de enfermedad de Mucha-Habermann. El paciente recibió tratamiento con esteroide y antimicrobiano, al que respondió favorablemente. Al momento de este informe, las lesiones habían desaparecido. Conclusiones: la enfermedad de Mucha-Habermann es poco frecuente y requiere confirmación mediante biopsia de piel para tratarla adecuadamente. El caso que se describe es poco común por el tipo de paciente y la edad en que se manifestó la enfermedad.

[Gated single photon emission computed tomography (SPECT) and radionuclide ventriculography for evaluate the left ventricle ejection fraction in heart transplant recipients. Comparative study]. / Comparación de la ventriculografía isotópica de equilibrio y la tomografía computarizada con emisión de fotones individuales (SPECT) sincronizado para evaluar la fracción de expulsión del ventrículo izquierdo en pacientes trasplantados de corazón.

OBJECTIVE: To evaluate which is the best method to determine the left ventricular ejection fraction in heart transplant recipients: radionuclide ventriculography or gated SPECT, compared with echocardiography as the gold standard method. MATERIAL AND METHODS: A prospective, transversal, observational, and open study including all orthotopic heart transplant recipients between January 1, 1993 and December 31, 2010 was realized after signed Informed Consent, and we performed echocardiography, radionuclide ventriculography and gated SPECT in 14 patients. Normal value for left ventricle ejection fraction was considered 50% in all the methods. RESULTS: Fourteen heart transplant recipients were considered for the study. Two patients were excluded because of arrhythmic heartbeat at the time of gated SPECT acquisition and two by being newly transplanted. The mean left ventricle ejection fraction was: echocardiography: 69.9%;gated SPECT: 60%; radionuclide ventriculography: 61.1%. The sensitivity of gated SPECT was 75% and 100% for radionuclide ventriculography. Specificity could not be obtained because our population was very small and there were no false negatives. (All the echocardiography results were over 50%). CONCLUSION: It was concluded that despite our small population, the gated SPECT was a useful tool in the evaluation of heart transplant patients due to its functional and prognostic information, besides offering myocardial perfusion imaging.

[Heart transplant program at the UMAE, General Hospital Dr. Gaudencio González Garza, of the La Raza National Medical Center]. / Programa de trasplante cardiaco de la unidad Médica de Alta Especialidad, Hospital General Dr. Gaudencio González Garza, del Centro Médico Nacional la Raza.

BACKGROUND: The heart transplantation has modified the life expectancy of patients with terminal heart failure. OBJECTIVE: To present our experience in heart transplantation. MATERIAL AND METHODS: A retrospective cohort study was realized for heart transplant recipients between July 21, 1988 and May 30, 2011. We evaluated the procedure for evaluation and selection of heart donors and heart transplant recipients. Also we reviewed etiology of cardiomiopathy, age and gender of patients, surgical procedure, and postoperative evolution, immediate and long-term survival. RESULTS: Of all 233 heart transplants performed in Mexico, 64 were done in our hospital. Seven cases were excluded due to incomplete information. We present 57 heart transplantation performed in 56 patients (one retransplantation): 27 cases with dilated cardiomiopathy (47.35%), 23 with ischemic cardiomiopathy (40.35%), four patients with terminal heart valve disease (7.0%), two with restrictive cardiomiopathy (3.5%) and one retransplantation (1.8%). Forty-six male patients (82.1%), and 10 female cases (17.9%). The mean age was 40.9 +/- 15.6 years-old (8-66 years-old). In 22 years the immediate mortality was 30.3% and the main cause was primary graft failure. The longest survival has been 10 years. All survival recipients are in functional class I. CONCLUSION: It was concluded that heart transplantation is a feasible surgical option in our country for terminal heart disease.

[Heart transplantation for the treatment of isolated left ventricular myocardial noncompaction. First case in Mexico]. / Trasplante cardiaco: una opción para tratamiento del miocardio no compactado aislado de ventrículo izquierdo. Primer caso en México.

BACKGROUND: Myocardial noncompaction of the left ventricle is a congenital cardiomyopathy characterised by left ventricular hypertrabeculation and prominent intertrabecular recesses. The incidence ranges from 0.15% to 2.2%. Clinical manifestations include heart failure, arrhythmias, and stroke. Prognosis is fatal in most cases. Heart transplantation is a therapeutic option for this cardiomyopathy, and few had been made worldwide. CLINICAL CASE: The case is presented of a 20 year-old male with noncompacted myocardium of the left ventricle, who had clinical signs of heart failure. His functional class was IV on the New York Heart Association scale. He was successfully transplanted. Its survival to 15 months is optimal in class I New York Heart Association, and endomyocardial biopsies have been reported without evidence of acute rejection. CONCLUSION: It is concluded that heart transplantation modified the natural history and improved survival in patients with this congenital heart disease.

[Routine hormonal therapy in the heart transplant donor]. / Terapia hormonal de rutina en el donador para trasplante cardiaco.

BACKGROUND: Successful heart transplantation depends largely on donor heart function. During brain death many hormonal changes occur. These events lead to the deterioration of the donor hearts. The 2002 Crystal Consensus advises the use of a triple hormonal scheme to rescue marginal cardiac organs. MATERIAL AND METHODS: A prospective, longitudinal study was conducted on potential donor hearts during the period 1 July 2011 to 31 May 2013. All donor hearts received a dual hormonal rescue scheme, with methylprednisolone 15mg/kg IV and 200mcg levothyroxine by the enteral route. There was at least a 4 hour wait prior to the harvesting. The preload and afterload was optimised. The variables measured were: left ventricular ejection fraction cardiac graft recipient; immediate and delayed mortality. RESULTS: A total of 30 orthotopic heart transplants were performed, 11 female and 19 male patients, with age range between 19 and 63 years-old (Mean: 44.3, SD 12.92 years). The donor hearts were 7 female and 23 male, with age range between 15 and 45 years-old (mean 22.5, SD 7.3 years). Immediate mortality was 3.3%, 3.3% intermediate, and delayed 3.3%, with total 30 day-mortality of 10%. Month survival was 90%. The immediate graft left ventricular ejection fraction was 45%, 60% intermediate, and 68% delayed. The causes of death were: 1 primary graft dysfunction, one massive pulmonary embolism, and one due to nosocomial pneumonia. CONCLUSION: It was concluded that the use of double rescue scheme hormonal therapy is useful for the recovery and preservation of the donor hearts. This scheme improves survival within the first 30 days after transplantation.

Dispositivos de asistencia ventricular como tratamiento de destino. A propósito de un caso / Ventricular assist devices as destination treatment. About a case

Resumen El tratamiento de la falla cardiaca terminal avanzada ha sido el trasplante de corazón, sin embargo, hay limitantes en cuanto a las características del receptor y disponibilidad de donadores, por lo que se ha utilizado alternativamente el soporte ventricular como tratamiento de destino. Se describe a una paciente con falla cardiaca terminal por cardiomiopatía isquémica en quien se implantó exitosamente un sistema de soporte ventricular izquierdo y a ocho meses del procedimiento se encontraba en clase funcional I, sin complicaciones.

Abstract The treatment of refractory terminal heart failure has been heart transplantation. However, there are limitations with regard to clinical conditions of the recipient and availability of donors, and ventricular support has therefore been alternatively used as destination therapy. We describe the case is of a female patient with ischemic cardiomyopathy-associated heart failure who had a left ventricular assist device successfully implanted and at eight months of the procedure was at functional class I, with no complications.

[Brain death, physiopathology, optimal care and hormonal therapy for cardiac donation]. / Muerte encefálica, fisiopatología, cuidado óptimo y terapia hormonal para donación cardíaca.

Heart transplantation goes on leading the standard therapy for the terminal heart failure. The success of this procedure and the post-transplantation survival, meaning during the perioperative time, is variable because of the good performance of the donor graft, due to this situation, the pre-harvesting evaluation is very important. The brain death brought many changes: 1) first of all the "adrenergic storm" with its hemodynamic and cardiac dangerous events; 2) Thyroidal hormones, cortisol, vasopressin, and seric insulin depletion with its metabolic consequences respectively. Since 2002 during the Crystal Consensus started the using of the hormonal therapeutic with triyodothironine, vasopressin and metilprednisolone for improving, meaning those limitrophes ones, the performance donor hearts with brain death, and the goal has been to harvest more donated organs en quality and numbers. This hormonal therapeutic has had great acceptation and is successful; having more harvesting of solids organs: hearts, lungs and kidneys; with more performance and surviving at 1 year post-transplantation and less mortality. Our Hospital began the hormonal therapeutic since January 2011with excellent results. On this basis we can concluded that, hormonal rescue therapy, improves the availability and performance of organs for transplantation.

[Distant heart procurement for transplantation]. / Procuración a distancia de corazóncon fines de trasplante.

BACKGROUND: The low availability of organ donors is a serious hindrance to heart transplantation. Long-distance organ procurement has been accepted as an option despite longer ischemic time for the heart. METHODS: Long-distance procurement from outside Mexico City in adult patients with terminal heart failure submitted to orthotopic heart transplantation between February 1st 2011, and January 31st 2012, was assessed. Ischemic time, distance from Mexico City, and perioperative and short-time mortality were determined. RESULTS: There were 14 orthotopic heart transplants during the analyzed period. In 12 cases long-distance heart procurement was required. Mean age of recipients was 42.7 years (range between 17 and 61 years). Seven patients were male and five female. Mean ischemic time was 228.58 minutes. The longest distance of procurement for land and air travel was 2,319 km; and the lowest, 22.5 km. Perioperative mortality was 8.33% (one patient), and there were 2 short-term deaths due to non-cardiac complications. In this series we included a case of heart-kidney transplantation from same donor. CONCLUSION: At our hospital, long-distance procurement for heart transplantation is a useful procedure with good results.