Heart Transplantation

IJCS

Case Report

Inflammatory Cardiomyopathy as a Cause of Recurrent Ventricular Tachycardia Requiring Heart Transplant

Flora Elisa Cabello Montoya et al. Yulia Vadimovna Stavtseva Marina Teterina Anton Vorobiev Zhanna Kobalava

Introduction

The most common setting for ventricular tachycardia (VT) is ischemic heart disease, in which myocardial scar tissue is the substrate for arrhythmia.^, However, in some myocardial diseases (i.e., myocarditis, arrhythmogenic and dilated cardiomyopathies [DCM]), electrical abnormalities can precede apparent structural changes rendering diagnosis and treatment difficult.

The present study describes a case of inflammatory cardiomyopathy that appeared as a recurrent VT and required a heart transplant as the only therapeutic alternative after 20 years of the disease.

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IJCS

Original Article

Demographic and Epidemiological Profile of Aging and Elderly Patients Receiving Heart Transplant During the Period from 2009 to 2018

Joseane de Souza Ribeiro et al. Maria Liz Cunha de Oliveira

Abstract

Background:

The aging process may be associated with the accumulation of a wide variety of health damages, such as cardiovascular diseases. HF is the final common path of the majority of these diseases, and, in its refractory form, heart transplantation continues to be the best treatment choice.

Objective:

To describe the demographic and epidemiological profile of aging and elderly patients receiving heart transplant from 2009 to 2018.

Methods:

Retrospective, descriptive longitudinal study on heart transplantation in aging and elderly patients using data from medical records and institutional documents.

Results:

From a total of 234 transplant recipients, 127 were 45 years or older. For the demographic profile, the variables used were sex, age, marital status, home state, and profession. For the epidemiological profile, the variables used were previous diagnosis, comorbidities before and after transplantation, and survival. Age varied from 45 to 74 years, with a mean of 57 years. The male sex accounted for 58.27% of recipients, and 59.84% were from the Federal District. Chagas, dilated, and ischemic cardiomyopathy accounted for 66.14%, 18.9%, and 14.17% of transplants, respectively. The main comorbidities were Chagas disease (66.14%), malignant arrhythmia requiring cardioverter-defibrillator implantation (28.35%), arterial hypertension (27.56%), and dyslipidemia (15.75%). Mean survival was 3 years and 4 months.

Conclusion:

The demographic profile showed that the majority of patients were aging, male, married, and from the Federal District. The epidemiological profile showed that Chagas cardiomyopathy was the main cause of HF, followed by dilated cardiomyopathy.

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IJCS

Original Article

Electromyographical and Physiological Correlation in Patient with Heart Disease

Renata Luísa Bona et al. Artur Bonezi Carlo M Biancardi Flavio Antonio de Souza Castro Nadine Clausell

Abstract

Background:

Walking is an economic activity, the more efficient the mechanical contribution, the less metabolic energy is necessary to keep walking. Patients with chronic heart failure and heart transplant present peripheral musculoskeletal disorders, dyspnea, and fatigue in their activities.

Objective:

In this scenario, the present study sought to verify the correlations between metabolic and electromyographic variables in chronic heart failure, heart transplant patients, and healthy controls.

Methods:

Regression and correlation between cost of transport and electromyographic cost, as well as correlation between oxygen consumption and muscle coactivation in patients and controls at five different walking speeds have been performed, with alpha = 0.05.

Results:

Strong correlation values (r controls: 0.99; chronic heart failure: 0.92; heart transplant: 0.88) indicate a linear relationship between the cost of transport and electromyographic cost. Oxygen consumption was significantly correlated to muscle activation in all groups.

Conclusion:

These results suggested that dynamic muscle coactivation was an important factor, especially for CHF and HT. These data support the idea that peripheral muscle limitations play an important role in people with CHF and HT. These findings indicate a strong relation between metabolic and electromyographic variables. For chronic heart failure and heart transplant patients, it can help to explain some difficulties in daily activities and aid in physical rehabilitation.

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IJCS

Review Article

Heart Transplantation for Chagas Cardiomyopathy

Maria da Consolação Moreira et al. Fabio Morato Castilho Renato Braulio Guilherme Ferraz Messina de Pádua Andrade José Renan da Cunha Melo

Abstract

Heart transplantation (HT) is an established treatment for patients with advanced heart failure (HF). Chagas disease (CD), caused by the Trypanosoma cruzi (T.cruzi) is an important cause of HF in Latin America. Considering CD is a chronic infectious disease, the use of immunosuppressive therapy after HT can reactivate T. cruzi infection and compromise outcomes. Early diagnosis and treatment of this complication is extremely important, which requires knowledge, experience, and a high degree of suspicion by transplant physicians. Furthermore, with the international immigration of people, CD is no longer exclusive to Latin America, since a large number of immigrants with T. cruzi infection are living in non-endemic countries. This phenomenon represents not only a new global epidemiological problem, but also a challenge for transplant teams. This review aims to discuss the peculiarities of HT in the context of CD, with a focus on reactivation of the infection, clinical manifestations, etiological treatment of T. cruzi and differential diagnosis with allograft rejection, among HT recipients.

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ABC

Original Article

Heart transplantation in neonates and children. Intermediate-term results

Estela Azeka et al. Miguel Barbero-Marcial Marcelo Jatene Paulo Roberto Camargo … José Otávio C. Auler Edmar Atik José Antonio F. Ramires Munir Ebaid

OBJECTIVE: To assess intermediate-term outcome in children who have undergone orthotopic heart transplantation. METHODS: We carried out a longitudinal and prospective study between October ’92 and June ’99 comprising 20 patients with ages ranging from 12 days to 7 years (mean of 2.8 years). We employed a double immunosuppression protocol with cyclosporine and azathioprine and induction therapy with polyclonal antithymocyte serum. Survival and complications resulting from the immunosuppression protocol were analyzed. RESULTS:The double immunosuppression protocol and the induction therapy with polyclonal antithymocyte serum resulted in an actuarial survival curve of 90% and 78.2% at 1 and 6 years, respectively, with a mean follow-up period of 3.6 years. One patient died due to acute rejection 40 days after transplantation; another patient died 2 years after transplantation due to lymphoproliferative disorder; a third patient died because of primary failure of the graft; and a fourth patient died due to bronchopneumonia. The major complications were as follows: acute rejection, infection, nephrotoxicity, and systemic hypertension. The means of rejection and infection episodes per patient were 2.9 and 3.4, respectively. After one year of transplantation, a slight reduction in the creatinine clearance and systemic hypertension were observed in 7 (38.9%) patients. CONCLUSION: Heart transplantation made life possible for those patients with complex congenital heart diseases and cardiomyopathies in refractory congestive heart failure constituting a therapeutical option for this group of patients in the terminal phase.

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ABC

Original Article

Noninvasive diagnosis of allograft vascular disease after heart transplantation

Fernando Bacal et al. Noedir Antonio Groppo Stolf Viviane Cordeiro Veiga William A. Chalela … Cesar Grupi Ana Clara Rodrigues Eulógio E. Martinez Alfredo Inácio Fiorelli Luiz Felipe Pinho Moreira Edimar Alcides Bocchi Giovanni Bellotti José Antonio Franchini Ramires

OBJECTIVE: To determine the predictive values of noninvasive tests for the detection of allograft vascular disease. METHODS: We studied 39 patients with mean ages of 48±13 years and a follow-up period of 86±13 months. The diagnosis of allograft vascular disease was made by cine-coronary arteriography, and it was considered as positive if lesions existed that caused > or = 50% obstruction of the lumen. Patients underwent 24h Holter monitoring, thallium scintigraphy, a treadmill stress test, and dobutamine stress echocardiography. Sensitivity, specificity, and positive and negative predictive values were determined in percentages for each method, as compared with the cine-coronary arteriography results. RESULTS: Allograft vascular disease was found in 15 (38%) patients. The Holter test showed 15.4% sensitivity, 95.5% specificity. For the treadmill stress test, sensitivity was 10%, specificity was 100%. When thallium scintigraphy was used, sensitivity was 40%, specificity 95.8%. On echocardiography with dobutamine, we found a 63.6% sensitivity, 91.3% specificity. When the dobutamine echocardiogram was associated with scintigraphy, sensitivity was 71.4%, specificity was 87%. CONCLUSION: In this group of patients, the combination of two noninvasive methods (dobutamine echocardiography and thallium scintigraphy) may be a good alternative for the detection of allograft vascular disease in asymptomatic patients with normal ventricular function.

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ABC

Original Article

Treatment of persistent rejection with methotrexate in stable patients submitted to heart transplantation

Fernando Bacal et al. Viviane Cordeiro Veiga Alfredo Inácio Fiorelli Giovanni Bellotti … Edimar Alcides Bocchi Noedir Antonio Groppo Stolf José Antonio Franchini Ramires

OBJECTIVE:To evaluate the use of methotrexate for the treatment of recurrent rejection in heart transplant recipients. METHODS: We studied 6 patients submitted to heart transplantation that showed rejection grade > or = 3A (ISHLT) in two consecutives endomyocardial biopsy specimens. The dose was 11.26±3.75mg/week. The evaluated data were: ventricular function, endomyocardial biopsy, white cell count and number of rejection episodes before and after methotrexate administration. RESULTS: There was a reduction in the number of rejection episodes (5.17±1.47 before methotrexate; 2.33±1.75 after 6 months and 3.17±2.99 after 12 months of treatment, p=0.0193). The ventricular function was normal with ejection fraction of 76.5±4.80 before and 75.6±4.59 after methotrexate (p=0.4859). One patient did not finish the treatment because he showed signs of rejection associated with severe pericardial effusion. Five patients had a reduction in the white cell count (8,108±23.72 before and 5650±1350 after methotrexate, p=0.0961). One pulmonary infection with complete resolution after antibiotic treatment was observed. CONCLUSION: Methotrexate in low doses is an effective adjunct therapy in the treatment of recurrent rejection after heart transplantation.

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