Heart Transplantation – ABC CARDIOL

ABCHF

Case Report

Wolff–Parkinson–White Syndrome in a Heart Transplant Recipient

Adir Schreiber Junior et al. Lucas Simonetto Faganello Ana Paula Arbo Magalhães Kaleb Pinto Spannemberger … Eduardo Caberlon Leandro Ioschpe Zimerman Mauricio Pimentel

Abstract

A 44-year-old woman underwent heart transplantation due to refractory angina and advanced heart failure. During the postoperative period, she developed episodes of supraventricular tachycardia and intermittent ventricular pre-excitation on the electrocardiogram. After an initial period of pharmacological management, she underwent successful radiofrequency ablation of a left posteroseptal accessory pathway. A review of the literature regarding Wolff–Parkinson–White syndrome in heart transplant recipients is also presented.

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ABC

Original Article

Percutaneous Axillary Intra-Aortic Balloon Pump Implantation in Patients Hospitalized with Heart Failure: Initial Brazilian Experience

Bruno Alves da Mota Rocha et al. Pedro H. M. C. de Melo Luis Mapa Rafael Nunes Oliveira … Antônio Fernando Freire Hernán Patricio García Mejía Vanessa Corcioli Bellini Liliane Kopel Silvia Gelás Lage Fabiana Goulart Marcondes-Braga Sandrigo Mangini Monica S. Ávila Iascara Wozniak de Campos Fernando Bacal Fábio Sândoli de Brito Jr Alexandre A. Abizaid Pedro Felipe Gomes Nicz

Abstract

Background

The intra-aortic balloon pump (IABP) is the most widely used mechanical circulatory support device for patients with advanced heart failure (HF) in our setting. However, femoral implantation restricts patient mobility during support.

Objective

To report the initial experience of a Brazilian advanced HF referral center with percutaneous axillary IABP implantation.

Methods

Consecutive patients hospitalized for HF who underwent percutaneous axillary IABP implantation at a tertiary cardiology referral center were included. A p-value < 0.05 was considered statistically significant.

Results

Between December 2020 and December 2023, 22 patients underwent percutaneous axillary IABP implantation. The mean age was 53 ± 10.7 years. All patients were hospitalized with refractory HF and were listed for heart transplantation. The procedure was successfully performed in all patients selected for the axillary approach. The median duration of support was 15 days (interquartile range: 7–28 days). Observed complications included device migration (18.2%), limb ischemia (9.1%), and isolated infectious and neurological events. Half of the patients either underwent heart transplantation or were successfully weaned from mechanical support.

Conclusion

The initial experience with percutaneous axillary IABP implantation demonstrated that the technique is feasible, safe, and reproducible. Further studies are needed to establish the role of this strategy within the continuum of care for patients hospitalized with advanced HF while awaiting heart transplantation.

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ABCHF

Viewpoint

What We Choose to Fund Defines Who We Choose to Save: Pediatric Heart Failure in Emerging Economies

Carolina Vieira de Campos et al. Luiz Fernando Caneo Tamara J. Pimenta Desiree S. Machado

Management of pediatric advanced heart failure (HF) in low- to middle-income countries faces substantial and interconnected challenges, including severely limited access to specialized care, a shortage of adequately trained healthcare professionals, delayed referrals, and high mortality rates. These systemic constraints significantly restrict both the availability and the effectiveness of life-saving therapies for children with end-stage HF.

A deeper understanding of mechanical circulatory support (MCS) in emerging economies – illustrated here through the Brazilian experience – provides a valuable foundation for identifying structural, logistical, and ethical barriers to care. Such analysis also informs the development of strategies aimed at the sustainable and equitable expansion of advanced HF therapies for children.

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ABCHF

Editorial

ABC Heart Failure & Cardiomyopathy: Management Review and Indexing Perspectives

Germano Emílio Conceição-Souza

Introduction – context and mission

ABC Heart Failure & Cardiomyopathy (ABC HF) was established in 2021 as a specialized journal within Brazilian Society of Cardiology’s (SBC) family of scientific journals. The creation of ABC HF responded to a longstanding request from the Department of Heart Failure (DEIC-SBC) for a dedicated platform for disseminating high-quality research in the fields of heart failure and cardiomyopathies, including their various diagnostic and therapeutic approaches.

The mission of ABC HF goes beyond merely publishing scientific articles. The journal aims to create an environment that encourages the production and dissemination of knowledge, thereby strengthening scientific exchange and establishing itself as a reliable source of information for researchers and healthcare professionals in Portuguese-speaking countries and Latin America, regions that are particularly affected by the significant impact of heart failure.

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ABCHF

Viewpoint

The Heart Transplant Prioritization System in Brazil: Challenges and Perspectives on the Use of Home Inotropes

Helena Garcia Betinardi Bernardi et al. Edimar Alcides Bocchi

Introduction

Despite advances in the treatment of heart failure with reduced ejection fraction (HFrEF), the disease still represents a significant clinical challenge, especially in advanced stages. It is estimated that up to 13% of patients do not respond to conventional therapies, progressing to severe forms of the syndrome, which are associated with high morbidity and mortality.^,

Globally, about 64 million people live with HF, and in Brazil, 941,576 hospitalizations due to HF were recorded between 2019 and 2023, with a progressive increase during this period. In 2023, the incidence was 101.83 cases per 100,000 inhabitants. These numbers reflect not only the magnitude of the problem but also the burden it imposes on the healthcare system.

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ABCHF

Review Article

Reverse Remodeling and Genetics: A Review Based on a Clinical Case Description that Challenges Current Evidence and Logic

Helena Garcia Betinardi Bernardi et al. Silas Furquim Renata Lopes Hames Jorge Henrique Yoschimoto Koroishi … Jairo Alves Pinheiro Junior Stevan Krieger Martins

Abstract

Cardiac remodeling, present in heart failure (HF), is a compensatory biological process following an initial myocardial injury that gradually becomes maladaptive, leading to clinical deterioration and chronic HF. Reverse remodeling (RR), which has been increasingly addressed, occurs when the geometry and/or function of the left ventricle recover in response to treatment, approaching normal cardiac structure. RR is associated with a better prognosis. Factors associated with RR include female sex, non-ischemic etiology, mild to moderate HF, lower fibrotic burden, elevated blood pressure permitting medical optimization, shorter disease duration, and preserved renal function. However, growing knowledge of genetic factors in HF etiology has provided important insights into their role in treatment response and prognosis. To illustrate and discuss these emerging topics, we report a case of advanced HF involving RR and a genetic variant, reviewing current recommendations for management.

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ABCHF

Case Report

Recurrent Supraventricular Tachycardia in a Patient with Heart Transplant

Lucas Grumann Bernardon et al. Adir Schreiber Junior Lucas Faganello Mauricio Pimentel … Ana Paula Magalhães Leandro Zimerman

Identification

Female patient, 58 years old.

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ABCHF

Viewpoint

Right Ventricular Pseudoaneurysm after Heart Transplantation: a rare complication associated with Endomyocardial Biopsy

Lucas Mollinari Veloso da Silveira et al. Joana Carolina Junqueira de Brum Luiz Claudio Danzmann Diego Costa Cardoso … Estevan Letti Marcela Cunha Sales Fernando Antônio Lucchese

Introduction

Cardiac pseudoaneurysms occur when a rupture in a blood vessel or myocardial wall is contained by surrounding structures such as the pericardium, thrombus, or adhesions. Unlike true aneurysms, pseudoaneurysms are more susceptible to late, potentially fatal ruptures.^, These lesions most commonly develop as complications of myocardial infarction, typically involving the left ventricle.

Less frequently, pseudoaneurysms can form in the right ventricle due to lipoma, postcardiac surgery, following device lead extraction, in the infectious setting, after remote myocardial infarction, as a complication of endomyocardial biopsy, and after penetrating chest wall trauma. The optimal management of right ventricular pseudoaneurysms is not well established, with current strategies focused on preventing rupture.

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ABC

Case Report

Cardiac Sarcoidosis Reactivation in a Transplanted Heart: An Unusual Case of New Graft Dysfunction

Manuela Cristina Ribeiro Dias Barroso et al. Heleutério da Conceição Nicolau Madogolele Danielle Louvet Guazzelli Luis Fernando Bernal da Costa Seguro … Fabiana Goulart Marcondes-Braga Sandrigo Mangini Monica Samuel Ávila Gabriel Barros Aulicino Iascara Wozniak Campos Samuel Padovani Steffen Fabio Antonio Gaiotto Fernando Bacal

Introduction

Cardiac sarcoidosis (CS) is an uncommon yet potentially life-threatening manifestation of systemic sarcoidosis. Recurrence of CS following heart transplantation (HTx) is an exceedingly rare event and presents a significant diagnostic challenge.

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ABCHF

Review Article

History and Application of Mechanical Assist Devices as a Bridge to Heart Transplant: A Review and Perspectives in Brazil

Alvaro Perazzo et al. Fabio Antônio Gaiotto Samuel Padovani Steffen Shirlyne Fabianni Dias Gaspar … Vanessa Simioni Faria Rebeca Cavalcante Silva Ferreira Aline Carbonera Danielle Louvet Guazzelli Jael Andrea Rioja Gamboa Leonardo Flud Ideal Helen Lima Gomes Alexandre Targino Gomes Falcão Filho Andre Loureiro Fernandes Luiza Hermanny Campos Camila Lambert Steffen Carolina Limongi Renato Leal Varjão Monica Samuel Avila Luis Fernando Bernal da Costa Seguro Sandrigo Mangini Fabiana Goulart Marcondes-Braga Gabriel Barros Aulicino Iascara Wozniak de Campos Ronaldo Honorato Barros Santos Domingos Dias Lourenço Filho Mariusz Kowalewski Daniele Ronco Matteo Matteucci Paolo Meani Claudio Francesco Russo Michele di Mauro Silvia Mariani Antonio Loforte Dominik Wiedmann Fernando Bacal Glenn Whitman Prakash Punjabi Roberto Lorusso Fabio Biscegli Jatene

Abstract

Mechanical circulatory support (MCS) devices have evolved significantly over the past decades and play a vital role in managing end-stage heart failure, especially as a bridge to heart transplantation. From the pioneering heart-lung machines to third-generation ventricular assist devices (VADs), MCS technology has advanced to provide more durable, efficient, and safer options for both short- and long-term support. This review outlines the historical development of mechanical assist devices, the types of available supports – ranging from intra-aortic balloon pumps and extracorporeal membrane oxygenation to implantable devices like HeartMate 3 – and their clinical indications and complications. Special attention is given to right ventricular dysfunction, thromboembolic and hemorrhagic complications, and infections, which remain major challenges in the management of patients with MCS devices. In Brazil, despite the growing evidence supporting MCS in critically ill patients, access remains limited due to financial and systemic constraints. The review explores the current landscape of device availability in the country, national guidelines, cost-effectiveness data, and the impact of recent changes in transplant allocation criteria that prioritize patients receiving mechanical support. Notably, the approval of long-term VADs for destination therapy in the public health system in 2024 marks a significant milestone. This review offers a comprehensive perspective on MCS utilization, highlighting both global advances and Brazil-specific challenges. By identifying gaps in access and proposing future directions, it advocates for expanded use of these life-saving technologies to improve survival and quality of life in advanced heart failure patients.

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ABC

Research Letter

Unveiling the Genetic Puzzle: Asymmetric Hypertrophy in a Heart Transplant Recipient Linked to Birt-Hogg-Dubé Syndrome

Silas Ramos Furquim et al. Lucas Vieira Lacerda Pires Nara Alves Buriti Mariana Lombardi Peres de Carvalho … Emanuelle Leonilia Marques Bianca Domit Werner Linnenkamp Luciana Sacilotto Fabiana G. Marcondes-Braga Iascara Wozniak de Campos Luis Fernando Bernal da Costa Seguro Sandrigo Mangini Monica S. Avila Fernando Bacal José Eduardo Krieger

Abstract

A case of a 54-year-old man who underwent a heart transplant with early asymmetric hypertrophy unrelated to rejection. Donor’s genetic analysis revealed a variant in folliculin gene, associated with Birt-Hogg-Dubé Syndrome. Screening of the donor’s family uncovered a similar hypertrophy and same genetic variant in the donor’s father. Although genetic evaluation of donors’ tissues is not routine, it can be crucial for understanding changes unrelated to the transplant procedure and identifying carriers of pathogenic variants.

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ABCHF

Case Report

Reversal of Type 2 Pulmonary Hypertension after Levosimendan: A Challenging Approach Bringing New Insights

Helena Garcia Betinardi Bernardi et al. Deborah de Sá Pereira Belfort Bruno Biselli Paulo Roberto Chizzola … Robinson Tadeu Munhoz Silvia M. Ayub-Ferreira Edimar Alcides Bocchi

Abstract

Among the inotropic agents used in the management of heart failure, levosimendan, in particular, has a selective venodilator property that appears to explain its clinical benefit during pulmonary hypertension (PH). Most of the evidence refers to patients with group 2 PH and consequent right ventricular (RV) dysfunction. In this scenario, the observed benefits may be due to the effect of levosimendan on RV contractility and pulmonary vessel dilation, or to the improvement of left ventricular function and consequent reduction of pulmonary congestion. What we have noticed is that more and more studies are being done on this action and applicability of the drug, appearing in small studies, reviews and formal indications.

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ABC

Research Letter

ABTO Brazilian Transplant Registry and ISHLT Heart Transplant Registry: An Important/Valuable Partnership

Fernando A. Atik et al. Paulo Manoel Pego-Fernandes Juan A. Mejia Livia A. Goldraich … Fabiana G. Marcondes-Braga Estela Azeka Fernando Augusto Figueira Valter Duro Garcia Luciana Haddad Wida Cherikh Josef Stehlik Rebecca Cogswell

Since 1983, data of more than 220,000 heart, lung and heart-lung transplant recipients from 481 heart transplant centers and 260 lung transplant centers in 47 countries have been submitted to the International Society for Heart and Lung Transplantation (ISHLT) Registry. The ISHLT Registry mission is to improve the care of patients with advanced heart and lung disease. The ISHLT Registry has engaged members from diverse regions, provided outcome data from thoracic transplants worldwide and catalyzed scientific and clinical collaboration. Ten Brazilian hospitals used to participate in the ISHLT Registry in the past. During this period, some problems were observed. First, there was heterogenous commitment among participating centers to the complete dataset. Second, there was lack of human resources in some hospitals dedicated to the Registry. Third, data collection was each center’s responsibility and submission of the data to the ISHLT registry was not mandatory.

In 2021, the ISHLT Registry was interrupted due to new data sharing regulations and data collection approaches. Data fields and data upload process were updated. In 2024, the ISHLT Registry began to exchange data only with national and regional registries, such as United Network for Organ Sharing and Eurotransplant, and no longer with individual hospitals or institutions.

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ABC

Original Article

Comparative Analysis of Conventional and Speckle Tracking Echocardiographic Variables between Patients with Unrejected Heart Transplants and Healthy Individuals

Aline Oliveira Martins Campo Dall’Orto et al. Maria Estefania Otto Simone Ferreira Leite Marco Antônio Freitas de Queiroz Maurício Filho … Natália Taveira Martins Samuel Rabelo Araújo Soraya Vasconcelos Almeida Luiza Valle Oliveira Brizida Fernando Antibas Atik

Abstract

Background

Echocardiography is essential for the assessment of patients with heart transplants. However, normal values in such individuals are not clearly defined.

Objectives

To compare conventional echocardiographic and speckle tracking variables between patients with unrejected heart transplants and healthy individuals.

Methods

: A prospective study was conducted with adult patients having undergone heart transplantation at least one year earlier and submitted to endomyocardial biopsy followed by transthoracic echocardiogram (TTE). Conventional TTE measures and mechanical heart strain assessments using speckle tracking were performed and the results were compared to those of a group of healthy volunteers. Statistical significance was set at 5% (p < 0.05).

Results

Thirty-six transplant patients without rejection were analyzed and compared to 30 healthy individuals. Chagas disease was the main reason for transplantation. Lower left ventricular global longitudinal strain expressed in absolute values was found (11.99% in transplant patients vs. 20.60% in controls; p <0.0001), right ventricular free wall longitudinal strain (16.67% in transplant patients vs. 25.50% in controls; p <0.0001) and myocardial work indices (p < 0.0001) as well as a larger size of the left atrium (38.17 ml/m2 in transplant patients vs. 18.98 ml/m2 in controls; p <0.0001) and greater mass and relative wall thickness (p <0.0001).

Conclusion

Stable patients having undergone heart transplants without rejection have differences concerning echocardiographic variables compared to healthy individuals. These findings indicate that conventional echocardiographic measures and heart mechanics are altered in transplant patients even in the absence of rejection. Such findings are relevant to the clinical context and follow-up of the patient.

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ABC

Case Report

Staged Heart-Kidney Transplantation with Renal Pulsatile Preservation: A Viable Approach for Combined Transplantation

Arthur Gus Manfro et al. Rodrigo Fontanive Franco Roberto Ceratti Manfro Nadine Clausell Livia Adams Goldraich

Introduction

Isolated heart and kidney transplants have become routine procedures for addressing end-stage organ failure. Notably, renal dysfunction is frequently observed in patients with advanced heart failure (HF), significantly impacting the prognosis of heart transplantation. Conversely, advanced HF is common in patients with end-stage renal disease (ESRD), often impairing kidney transplantation. Consequently, many centers are adopting combined heart and kidney transplantation (HKTx) as the standard of care for those patients. The progress in this field has led to a substantial increase in multiorgan transplants over the last decade. Despite the growth in HKTx, uncertainties persist regarding the preferred surgical sequence. In Brazil, while a significant number of isolated heart and kidney transplants are performed annually, only a few combined HKTx have been documented.^, Considering the advancements in the field, it is anticipated that combined transplants will become more commonplace shortly. Here, we present a case report of a staged HKTx with renal pulsatile perfusion preservation.

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ABCHF

Case Report

Pulmonary Embolism and Light Chain Cardiac Amyloidosis with Progression to Heart Transplant

Thales Quintella Drummond et al. Lígia Lopes Balsalobre Trevizan Sandrigo Mangini Fernando Bacal

Introduction

Cardiac amyloidosis results from the deposition of amyloid fibrils in the heart’s extracellular space. This chronic and progressive disease significantly reduces quality of life and carries a high mortality rate if not diagnosed and treated early. Myocardial damage occurs due to direct injury by blood peptides, as well as architectural distortion caused by the extracellular infiltrate, leading primarily to diastolic ventricular dysfunction but also systolic dysfunction, as the disease progresses and cardiac arrhythmias emerge. The most common subtypes include abnormal transthyretin peptides (ATTR) and immunoglobulin light chain (AL), with AL having a worse prognosis and heart transplantation being a potential treatment option. In the United States, the estimated incidence of light chain amyloidosis cardiomyopathy is 1 in 100,000 individuals.^, The primary risk factor for the development of light chain amyloidosis is a personal history of monoclonal gammopathy.

Cardiac manifestations often involve orthostatic hypotension, arrhythmias, ventricular hypertrophy inconsistent with electrically inactive regions on the electrocardiogram, and heart failure with preserved ejection fraction predominantly, though reduced ejection fraction may occur in advanced cases.

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ABC

Original Article

Absolute Lymphocyte Count: a Predictor of Positive Serum PCR for Trypanosoma cruzi in Patients with Chagas Disease Undergoing Heart Transplantation

Plínio José Whitaker Wolf et al. Marco Aurelio Finger João Manoel Rossi Neto Carolina Casadei Santos … Victor Bemfica de Mello Mattos Raphael Rossi Lucas Petri Damiani

Abstract

Background

It is unknown whether lymphopenia is a risk factor for the reactivation of Chagas disease in heart transplantation (HTx), as recently described in the reactivation of cytomegalovirus in transplant patients.

Objective

To evaluate whether lymphopenia in the perioperative period of heart transplantation is related to early Trypanosoma cruzi parasitemia.

Methods

This observational, retrospective study analyzed a sample from January 2014 to January 2023). Parasitemia was evaluated in the first 3 months after HTx using serum polymerase chain reaction (PCR) and compared with the total lymphocyte count in the perioperative period of HTx using receiver operating characteristic curves. Baseline characteristics were compared with PCR for Chagas using independent Cox proportional hazards models. A significance level of 5% was adopted.

Results

The sample (n = 35) had a mean age of 52.5 ± 8.1 years, and 22 patients (62.8%) had positive PCR for Chagas. The mean lowest lymphocyte values in the first 14 days after HTx were 398 ± 189 and 755 ± 303 cells/mm³ in patients with and without parasitemia, respectively, within 3 months after HTx (area under the curve = 0.857; 95% confidence interval: 0.996 to 0.718, sensitivity and specificity of 83.3% and 86.4%). A cutoff value of less than 550 lymphocytes/mm³ was determined as a risk factor for the presence of parasitemia. Patients with lymphocytes < 550 units/mm³ in the first 14 days after HTx presented positive PCR in 80% of cases. For every increase of 100 lymphocytes/mm³, the risk of PCR positivity was reduced by 26% (hazard rate ratio = 0.74; 95% confidence interval: 0.59 to 0.93, p = 0.009).

Conclusion

There was an association between lymphopenia in the perioperative period of HTx and early T. cruzi parasitemia detected by PCR.

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ABC

Letter to the Editor

Effects of Immunosuppression in Heart Transplant Patients Due to Chagas Disease

Lúcio Moreira Fontenele et al. Nayara Ribeiro Máximo de Almeida Breno Rennan de Souza Carvalho Egidio Bezerra da Silva Neto … Brenda dos Santos Teixeira Johnnatas Mikael Lopes

Cardiac involvement in Chagas Disease (CD) represents the most severe form of the disease, occurring in 30 to 40% of infected patients. Patients with heart failure of chagasic origin are often refractory to drug treatment, requiring assessment of the need for heart transplantation (CT). After carrying out the CT, it is necessary patient’s immunosuppression to ensure a greater chance of graft acceptance and vitality, on the other hand, immunosuppression is a contributing factor to CD relapse, which could directly compromise the graft or even worsen other health parameters of the patient, directly impacting mortality in the next 5 years after transplant. Many of the cardiac therapies implemented in CD come from therapies studied in heart diseases of other origins, requiring more therapeutic research in populations of individuals with CD.

The article entitled Survival of Survival of Heart Transplant Patients with Chagas’ Disease Under Different Antiproliferative Immunosuppressive Regimens presents a theme of extreme importance for the scenario of care for individuals with Chagas, especially concerning harmful outcomes such as death and reactivation of the disease.

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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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ABC

Original Article

Survival of Heart Transplant Patients with Chagas’ Disease Under Different Antiproliferative Immunosuppressive Regimens

Silas Ramos Furquim et al. Luana Campoli Galbiati Monica S. Avila Fabiana G. Marcondes-Braga … Julia Fukushima Sandrigo Mangini Luis Fernando Bernal da Costa Seguro Iascara Wozniak de Campos Tania Mara Varejão Strabelli Fernanda Barone Audrey Rose da Silveira Amancio de Paulo Luciana Akutsu Ohe Mariana Cappelletti Galante Fabio Antonio Gaiotto Fernando Bacal

Abstract

Background

Chagas’ disease (CD) is an important cause of heart transplantation (HT). The main obstacle is Chagas’ disease reactivation (CDR), usually associated to high doses of immunosuppressants. Previous studies have suggested an association of mycophenolate mofetil with increased CDR. However, mortality predictors are unknown.

Objectives

To identify mortality risk factors in heart transplant patients with CD and the impact of antiproliferative regimen on survival.

Methods

Retrospective study with CD patients who underwent HT between January 2004 and September 2020, under immunosuppression protocol that prioritized azathioprine and change to mycophenolate mofetil in case of rejection. We performed univariate regression to identify mortality predictors; and compared survival, rejection and evidence of CDR between who received azathioprine, mycophenolate mofetil and those who changed from azathioprine to mycophenolate mofetil after discharge (“Change” group). A p-value < 0.05 was considered statistically significant.

Results

Eighty-five patients were included, 54.1% men, median age 49 (39-57) years, and 91.8% were given priority in waiting list. Nineteen (22.4%) used azathioprine, 37 (43.5%) mycophenolate mofetil and 29 (34.1%) switched therapy; survival was not different between groups, 2.9 (1.6-5.0) x 2.9 (1.8-4.8) x 4.2 (2.0-5.0) years, respectively; p=0.4. There was no difference in rejection (42%, 73% and 59% respectively; p=0.08) or in CDR (T. cruzi positive by endomyocardial biopsy 5% x 11% x 7%; p=0.7; benznidazole use 58% x 65% x 69%; p=0.8; positive PCR for T. cruzi 20% x 68% x 42% respectively; p=0.1) rates.

Conclusions

This retrospective study did not show difference in survival in heart transplant patients with CD receiving different antiproliferative regimens. Mycophenolate mofetil was not associated with statistically higher rates of CDR or graft rejection in this cohort. New randomized clinical trials are necessary to address this issue.

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ABCIC

Review Article

My Approach to Echocardiographic Evaluation after Pediatric Heart Transplantation to Control Rejection and/or Graft Vascular Disease

Adailson Wagner da Silva Siqueira et al. Mirela Frederico de Almeida

Abstract

Pediatric heart transplantation is the definitive therapeutic option for patients with heart failure refractory to optimized clinical treatment, due either to cardiomyopathies or congenital heart disease. Morbidity and mortality remain concerning factors during evolution, and primary dysfunction, rejection, and graft vascular disease (GVD) are the main causes of death in the first 5 years after transplantation. As a surveillance method, transthoracic echocardiography has significant benefits in assisting diagnosis when there is clinical suspicion of rejection or GVD. The objective of this article is to present, in a clear and objective manner, which echocardiographic data assist pediatric cardiologists in follow-up of transplanted patients. The use of echocardiography, either through conventional tools or advanced methods, carefully focusing on different early and late post-cardiac transplantation phases, with information from current and comparative examination of evolution, mainly regarding tissue Doppler and longitudinal strain, can assist pediatric cardiologists in the decision to anticipate endomyocardial biopsy and coronary angiography (gold standard) for early diagnosis and immediate intervention, allowing greater graft durability.

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ABC

Research Letter

Cumulative Disorder of Myocardial Lipofuscin after Long-Term Heart Transplantation: A Study Based on Endomyocardial Biopsies

Luiz Alberto Benvenuti et al. Fabiana G. Marcondes-Braga Fernando Bacal

Introduction

Lipofuscin is a yellowish-brown, non-degradable cytoplasmic pigment composed of highly oxidized proteins, lipids, and metals. Lipofuscin accumulates over time in perennial post-mitotic cells such as cardiomyocytes and is also called “age pigment”.^–

Heart transplantation is an established treatment for patients with severe heart failure refractory to other forms of treatment. Its major long-term limitation is the development of cardiac allograft vasculopathy (CAV), which is relatively difficult to diagnose and for which few effective treatment options exist.^6,7 In this context, it is worth mentioning a previous study relating the amount of lipofuscin in the myocardium of heart transplant patients to the development of CAV.

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ABC

Research Letter

Orthotopic Heart Transplantation in a Covid-19 Recipient

Leonardo Rufino Garcia et al. André Monti Garzesi Julia Bazzo Sinatora Rejane Maria Tommasini Grotto … Andréia Cristina Passaroni Nelson Leonardo Kerdahi Leite de Campos Antônio Sérgio Martins Marcello Laneza Felicio Flávio de Souza Brito

Introduction

The coronavirus pandemic has affected more than 480 million people around the world. Solid organ recipients constitute a highly vulnerable group due to the need for immunosuppression and the various comorbidities that may be associated, many of which persist even after transplantation.

Transplanted patients can present a spectrum of clinical manifestations resulting from COVID-19: from asymptomatic, mild symptoms or acute respiratory failure and death. Some studies suggest that in the case of conditions with a favorable outcome, previous immunization and irreplaceable post-transplantation immunosuppression contribute to a response of less exacerbated inflammation and, consequently, less organic damage.^, Nonetheless, some reports and literature reviews show worse prognosis in transplanted patients, possibly due to comorbidities, advanced age, and lymphopenia often present.^,,

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ABC

Research Letter

Caseous Calcification of the Mitral Annulus: A Post-Heart Transplant Diagnosis

Bruno Jordão Chaves et al. Matheus Bitencourt Duarte Luiz Guilherme Passaglia Claudio Gelape … Paulo Hernane Rabelo Azevedo Geraldo Brasileiro Filho

Introduction

Caseous calcified mitral annulus is a non-neoplastic cardiac lesion considered to be a variant of mitral annular calcification that should be suspected when heart masses are detected by echocardiogram, chest x-ray or other radiologic studies.^– The majority of the patients is asymptomatic, but signs and symptoms of mitral regurgitation, systemic embolization and atrioventricular blocks have been described.³ The diagnosis is confirmed by anatomopathologic examination. The prognosis is good. Here, we present a caseous calcification of the mitral annulus case diagnosed after the pathologic analysis of explanted heart.

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