Heart Transplant – ABC CARDIOL

ABCIC

Case Report

Recurrent Intracardiac Masses in an Orthotopic Heart Transplant Recipient

Bilal Saeed et al. Natdanai Punnanithinont Shareef Mansour Paulo Savoia Promporn Suksaranjit

Introduction

As long-term survival improves among heart transplant recipients, rare post-transplant complications, including intracardiac masses, are being increasingly recognized.

Severe left atrial (LA) dilation and atrial arrhythmias may further contribute to blood stasis and thrombus formation in transplant recipients. LA thrombi in these patients may mimic neoplastic masses and represent important diagnostic and therapeutic challenges. Contributing factors include atrial dilation, arrhythmias, foreign material, and the components of Virchow’s triad, namely abnormal blood flow, endothelial injury, and hypercoagulability.^,

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ABC

Editorial

Do We Need New Echocardiographic Parameters for Transplant Recipients without Rejection?

Alberto Rodolpho Hüning et al. Vitor Emer Egypto Rosa

Introduction

Heart transplant represents the principal therapeutic modality for patients with end-stage heart failure unresponsive to maximized medical and surgical management. Brazil boasts one of the most extensive public health systems for organ transplantation globally, with nearly all procedures conducted under the Unified Health System (SUS). However, there is still a lack of studies validating normal echocardiographic parameters in this population, and this was the topic of the study conducted by Dall’Orto et al.

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ABCHF

Special Article

The 500th Heart Transplant – The Steps That Made Ceará a Reference in Heart Transplants in Brazil

Jefferson Luis Vieira et al. Maria Gyslane Vasconcelos Sobral Viviane Moreira Alves Germana Porto Linhares Almeida … Juliana Rolim Fernandes Laura Leite da Escossia Marinho Glauber Gean Vasconcelos Daniel Francisco de Mendonça Trompieri Glaylton Silva Santos Raissa Marianna Viana Diniz Juliana de Freitas Vasconcelos Sugette Ana Larissa Pedrosa Ximenes Juan Alberto Cosquillo Mejia João David de Souza Neto

The Beginning of Heart Transplantation in Ceará

The first heart transplant in Ceará occurred in the “cyclosporine era” at Hospital Antônio Prudente on February 20, 1993. The team consisted of surgeons José Glauco Lobo Filho (), João Martins de Souza Torres, Francisco Martins de Oliveira, José Maria Furtado Memória Junior, and Haroldo Brasil Barroso, in addition to Dr. Ricardo Lagreca (Natal/RN) as part of the Northeast Program for Heart Transplantation (NE-Tx). João David de Souza () Neto was the clinical cardiologist, and Fátima Sales and Miguel Arraes were the anesthesiologists. At that time, the NE-Tx provided support by sending collaborators with previous experience in the area, hence the valuable contribution of Dr. Lagreca from Natal. The NE-Tx assisted services from Sergipe, Alagoas, Pernambuco, Bahia, Rio Grande do Norte, and Ceará were discontinued after a few years.

In 1997, still at Hospital Antônio Prudente, a team composed of surgeons Juan Alberto Cosquillo Mejía, Valdester Cavalcante Pinto Júnior, Waldemiro Carvalho Júnior, Fernando Antônio de Mesquita and Haroldo Brasil Barroso, and anesthesiologist Rogean Nunes, in addition to cardiologists João David de Souza Neto and Patrícia Lopes de Sousa continued the heart transplant program in Ceará. On April 8, 1998, the same group and the pediatric cardiologists Klébia Castelo Branco and Ricardo Sardenberg were responsible for launching pediatric and neonatal transplantation in the North/Northeast regions.

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ABC

Research Letter

Cardiac Rehabilitation in a Transplanted Person with Emery-Dreifuss Muscular Dystrophy

Maria Loureiro et al. Carlos Branco João Duarte Gonçalo Coutinho … Maria Manuela Martins André Novo

Abstract

Emery-Dreifuss muscular dystrophy is a rare hereditary neuromuscular disease. Its manifestations begin primarily in childhood. The most frequent manifestations are progressive muscle weakness, atrophy that usually begins in the scapula-vertebral region, extending later to the pelvic girdle, and spinal stiffness. Patients can also manifest cardiac involvement as palpitations, syncope, exercise intolerance, congestive heart failure, and variable heart rhythm disturbances.^–The presence and severity of these manifestations can vary according to the individual and the disease’s subtypes. Cardiac involvement is the most worrisome feature of this disease, and there are some reports of the need for heart transplantation in this dystrophy.

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ABCHF

Original Article

Cognitive Frailty and Depressive Symptoms in Heart Transplant Candidates: Rational and Study Design

France Matos de Oliveira et al. Erika Tiemi Ikeda Luis Fernando Bernal da Costa Seguro Mônica Samuel Avila … Iascara Wozniak de Campos Marcus Vinicius B. Santos Maria Ignez Zanetti Feltrim Silvia Helena Gelas Lage Edimar Alcides Bocchi Victor Sarli Issa Miguel Morita Fernandes-Silva Fábio Antônio Gaiotto Fernando Bacal Fabiana Goulart Marcondes-Braga Sandrigo Mangini

Abstract

Background:

Patients with advanced heart disease have impaired cognitive abilities and higher probability of depressive symptoms. These factors contribute to negative outcomes of treatment, such as the development of comorbidities, higher hospitalization and mortality rates, poor treatment compliance and self-care, and decrease in quality of life and functionality.

Objective:

To describe the prevalence and to evaluate the impact of cognitive frailty in patients in the waiting list of heart transplantation, with death while waiting transplantation and priority transplantation as clinical outcomes.

Methods:

Longitudinal, prospective study evaluating cognitive frailty in 150 patients with advanced heart failure referred to transplantation in a hospital in Sao Paulo. Volunteers older than 18 years of age, hospitalized or in outpatient care, in the waiting list of transplantation will be considered eligible and will be assess within one month after being included in the waitlist. Cognitive performance will be assessed using the Montreal Cognitive Assessment and the battery of neuropsychological test Wechsler Abbreviated Scale of Intelligence (WASI). The symptoms of depression will be assessed by the Beck Depression Inventory.

Results:

The study will allow to describe the prevalence of cognitive frailty and its relationship with treatment outcomes in a Brazilian population.

Conclusion:

Data from this study will allow the analysis of associations between cognitive profile and severity of heart failure in patients referred to transplantation and their effects on clinical outcomes.

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ABC

Research Letter

Emerging Topics in Heart Failure: Contemporaneous Management of Advanced Heart Failure

Fabiana G. Marcondes-Braga et al. Jefferson L. Vieira João David de Souza Neto Gustavo Calado … Silvia Moreira Ayub-Ferreira Fernando Bacal Nadine Clausell

Definition

Advanced heart failure (HF) is a condition characterized by persistent severe HF symptoms, frequent episodes of decompensation, and progressive cardiac dysfunction despite optimal evidence-based treatment. These patients may be candidates for advanced therapies, such as heart transplantation (HT), mechanical circulatory support (MCS), and/or palliative care. It should be pointed out that some comorbidities, including pulmonary disease and liver and kidney dysfunction, are now included as possible major determinants of poor prognosis and should be considered during patient evaluation for advanced HF therapies.

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ABC

Artigo Original

Cardiorespiratory response during exercise in heart transplant recipients comparated to normal healthy subjects

Ana Fátima Salles et al. Japy Angelini Oliveira Fº Turíbio Leite de Barros Neto Dirceu Rodrigues de Almeida … Antonio Carlos de Camargo Carvalho Yara Juliano Ênio Buffolo Eulógio Emílio Martinez Fº

PURPOSE: To evaluate the cardiorespiratory response of heart transplant (HT) recipients. METHODS: Nine HT recipients (GI) underwent ergospirometric tests and were compared to 9 apparently healthy, sedentary subjects with similar sex, age, weight and height (GII). All were male patients aging 48±12 years, in functional class I (NYHA) an average of 23±21 months after HT. They were receiving cyclosporin, azathioprine, prednisone, dipyridamole and antihypertensive drugs. The tests were symptom-limited and they were interrupted due to exhaustion. RESULTS: During peak exercise, GI had a significantly lower physical performance related to lower VO2, VE, VEO2, HR, endurance time and work load. At the anaerobic threshold, VO2, endurance time and work load levels were also significantly lower in GI. The physical performance was similar between the groups in the 40W load. CONCLUSION: The cardiorespiratory performance in GI was significantly lower at peak exercise and similar to GII in the 40W load, showing the HT benefits cardiac patients during usual activities.

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