Skip directly to content

PubMed Heart Transplant

Subscribe to PubMed Heart Transplant feed PubMed Heart Transplant
NCBI: db=pubmed; Term=heart transplant
Updated: 1 hour 37 min ago

Supine fluid redistribution: should we consider this as an important risk factor for obstructive sleep apnea?

Fri, 08/10/2012 - 19:07
Related Articles

Supine fluid redistribution: should we consider this as an important risk factor for obstructive sleep apnea?

Sleep Breath. 2012 Aug 8;

Authors: Mirrakhimov AE

Abstract
INTRODUCTION: Obstructive sleep apnea (OSA) is a common medical disorder affecting at least 2 % of women and 4 % of men living in Western societies. Obesity, older age, male gender, alcohol and sedative use, smoking, craniofacial parameters, and volume overload are some of the risk factors for this disorder. DISCUSSION: OSA is a known risk factor complicating the course of arterial hypertension, heart failure, and chronic kidney disease. It is important to note that all of the aforementioned comorbid disorders are associated with volume overload. This explains why patients with OSA and comorbid disorders associated with fluid overload can benefit from treatment with diuretics and drugs modulating the renin-angiotensin-aldosterone system. Additionally, patients with heart failure and high sodium intake are at increased risk for OSA, further supporting the complex interrelationship. CONCLUSIONS: Hemodialysis and renal transplantation can markedly improve the severity of OSA in patients with concomitant kidney disease. Finally, there is a potential of a vicious cycle between OSA and fluid overload disorders, whereby OSA can contribute to the pathogenesis of arterial hypertension, heart failure, and chronic kidney disease, which in turn will significantly contribute to the course OSA.

PMID: 22872284 [PubMed - as supplied by publisher]

Parvovirus B19 Myocarditis Causes Significant Morbidity and Mortality in Children.

Fri, 08/10/2012 - 19:07
Related Articles

Parvovirus B19 Myocarditis Causes Significant Morbidity and Mortality in Children.

Pediatr Cardiol. 2012 Aug 8;

Authors: Molina KM, Garcia X, Denfield SW, Fan Y, Morrow WR, Towbin JA, Frazier EA, Nelson DP

Abstract
Although parvovirus B19 (PVB19) currently is the most common cause of viral myocarditis, limited pediatric data exist. Whereas other viruses infect cardiomyocytes, PVB19 targets coronary endothelium, leading to myocardial ischemia and dysfunction. A retrospective review investigated patients with polymerase chain reaction (PCR)-verified PVB19 myocarditis at Texas Children's Hospital and Arkansas Children's Hospital (January 2005 to August 2008). The primary end points of the study were transplant-free survival and circulatory collapse (death, mechanical support, or transplantation). For the 19 patients identified (age, 6 months to 15 years), the most common presenting symptoms were respiratory and gastrointestinal. At admission, all the patients demonstrated ventricular dysfunction requiring inotropic support (median ejection fraction, 24 %; median left ventricle end-diastolic diameter [LVEDD] z-score, 4.6). Whereas T-wave abnormalities were common, ST elevation was evident in five patients (two died and three required transplantation). Serum B-type natrietic peptide was elevated in all 12 patients tested (range, 348-8,058 pg/ml), and troponin I was high in 7 of 9 patients (range, 0.04-14.5 ng/ml). Of the 15 patients with circulatory collapse, nine received mechanical support, eight underwent successful transplantation, and five died. Only six patients (32 %) experienced transplant-free survival, and five patients had full recovery of function at discharge. In the transplant-free survival group, ST changes on presenting electrocardiography were less likely (p = 0.03), and the admission LVEDD z-score tended to be lower (3.3 vs 5.6; p = 0.08). In children, PVB19 myocarditis causes significant mortality and morbidity. Although mechanical intervention can support patients in the initial stage of decompensated heart failure, patients with PVB19 myocarditis often demonstrate persistent dysfunction requiring medical therapy and transplantation.

PMID: 22872019 [PubMed - as supplied by publisher]

Improving survival during heart transplantation: diagnosis of antibody-mediated rejection and techniques for the prevention of graft injury.

Fri, 08/10/2012 - 19:07
Related Articles

Improving survival during heart transplantation: diagnosis of antibody-mediated rejection and techniques for the prevention of graft injury.

Future Cardiol. 2012 Jul;8(4):623-35

Authors: Patel JK, Kobashigawa JA

Abstract
The diagnosis of antibody-mediated rejection (AMR) has presented a challenge due to the pleiomorphic immunologic responses that represent the condition. A consensus with regard to its pathological diagnosis continues to evolve. Due to an increasing number of sensitized patients undergoing heart transplantation, its incidence appears to be on the rise and the condition is associated with worse outcomes than acute cellular rejection. Treatment of AMR is also more difficult and response to increases in conventional immunosuppression is often limited. Risk factors for AMR include the use of ventricular assist devices, prior exposure to blood products, allografts and multiparity. Detection of alloantibodies with a high specificity and sensitivity allows risk stratification of recipients at potential risk of AMR. Desensitization and AMR treatment strategies are focused on several therapeutic targets, including suppression of T and B cells and elimination or inhibition of circulating antibodies.

PMID: 22871199 [PubMed - in process]

Actual situation in Eurotransplant regarding high urgent heart transplantation.

Fri, 08/10/2012 - 19:07
Related Articles

Actual situation in Eurotransplant regarding high urgent heart transplantation.

Eur J Cardiothorac Surg. 2012 Aug 5;

Authors: Smits JM

PMID: 22869253 [PubMed - as supplied by publisher]

[Cardiac surgery for patients with ventricular dysfunction].

Fri, 08/10/2012 - 19:07
Related Articles

[Cardiac surgery for patients with ventricular dysfunction].

Kyobu Geka. 2012 Aug;65(8):611-4

Authors: Doi K, Yaku H

Abstract
Coronary artery disease and aortic stenosis/regurgitation may cause irreversible myocardial damage, resulting in significant heart failure. Although the ultimate treatment of the end-stage heart failure is heart transplantation or ventricular assist devices, in most cases these patients still have some amount of functional and survival benefit by simple surgical treatment such as coronary artery bypass grafting (CABG) and valve replacement. However it is associated with significant perioperative mortality and morbidity.

PMID: 22868415 [PubMed - in process]

Human ES-cell-derived cardiomyocytes electrically couple and suppress arrhythmias in injured hearts.

Fri, 08/10/2012 - 19:07
Related Articles

Human ES-cell-derived cardiomyocytes electrically couple and suppress arrhythmias in injured hearts.

Nature. 2012 Aug 5;

Authors: Shiba Y, Fernandes S, Zhu WZ, Filice D, Muskheli V, Kim J, Palpant NJ, Gantz J, Moyes KW, Reinecke H, Van Biber B, Dardas T, Mignone JL, Izawa A, Hanna R, Viswanathan M, Gold JD, Kotlikoff MI, Sarvazyan N, Kay MW, Murry CE, Laflamme MA

Abstract
Transplantation studies in mice and rats have shown that human embryonic-stem-cell-derived cardiomyocytes (hESC-CMs) can improve the function of infarcted hearts, but two critical issues related to their electrophysiological behaviour in vivo remain unresolved. First, the risk of arrhythmias following hESC-CM transplantation in injured hearts has not been determined. Second, the electromechanical integration of hESC-CMs in injured hearts has not been demonstrated, so it is unclear whether these cells improve contractile function directly through addition of new force-generating units. Here we use a guinea-pig model to show that hESC-CM grafts in injured hearts protect against arrhythmias and can contract synchronously with host muscle. Injured hearts with hESC-CM grafts show improved mechanical function and a significantly reduced incidence of both spontaneous and induced ventricular tachycardia. To assess the activity of hESC-CM grafts in vivo, we transplanted hESC-CMs expressing the genetically encoded calcium sensor, GCaMP3 (refs 4, 5). By correlating the GCaMP3 fluorescent signal with the host ECG, we found that grafts in uninjured hearts have consistent 1:1 host-graft coupling. Grafts in injured hearts are more heterogeneous and typically include both coupled and uncoupled regions. Thus, human myocardial grafts meet physiological criteria for true heart regeneration, providing support for the continued development of hESC-based cardiac therapies for both mechanical and electrical repair.

PMID: 22864415 [PubMed - as supplied by publisher]

Cardiomyocyte Ca(2+) Handling and Structure is Regulated by Degree and Duration of Mechanical Load Variation.

Fri, 08/10/2012 - 19:07
Related Articles

Cardiomyocyte Ca(2+) Handling and Structure is Regulated by Degree and Duration of Mechanical Load Variation.

J Cell Mol Med. 2012 Aug 2;

Authors: Ibrahim M, Kukadia P, Siedlecka U, Cartledge JE, Navaratnarajah M, Tokar S, Van Doorn C, Tsang VT, Gorelik J, Yacoub MH, Terracciano CM

Abstract
Cardiac transverse (t)-tubules are altered during disease and may be regulated by stretch-sensitive molecules. The relationship between variations in the degree and duration of load and t-tubule structure is unknown, as well as its implications for local Ca(2+) -induced Ca(2+) release (CICR). Rat hearts were studied after 4 or 8 weeks of moderate mechanical unloading (using heterotopic abdominal heart-lung transplantation (HAHLT)) and 6 or 10 weeks of pressure overloading using thoracic aortic constriction. CICR, cell and t-tubule structure were assessed using confocal-microscopy, patch-clamping and scanning ion conductance microscopy. Moderate unloading was compared to severe unloading (using heart-only transplantation (HAHT)). Mechanical unloading reduced cardiomyocyte volume in a time-dependent manner. Ca(2+) release synchronicity was reduced at 8 weeks moderate unloading only. Ca(2+) sparks increased in frequency and duration at 8 weeks of moderate unloading, which also induced t-tubule disorganisation. Overloading increased cardiomyocyte volume and disrupted t-tubule morphology at 10 weeks but not 6 weeks. Moderate mechanical unloading for 4 weeks had milder effects compared with severe mechanical unloading (37% reduction in cell volume at 4 weeks compared to 56% reduction after severe mechanical unloading) and did not cause depression and delay of the Ca(2+) transient, increased Ca(2+) spark frequency or impaired t-tubule and cell surface structure. These data suggest that variations in chronic mechanical load influence local CICR and t-tubule structure in a time and degree-dependent manner, and that physiological states of increased and reduced cell size, without pathological changes are possible. © 2012 The Authors Journal of Cellular and Molecular Medicine © 2012 Foundation for Cellular and Molecular Medicine/Blackwell Publishing Ltd.

PMID: 22862818 [PubMed - as supplied by publisher]

Bosentan in heart transplantation candidates with severe pulmonary hypertension: efficacy, safety and outcome after transplantation.

Fri, 08/10/2012 - 19:07
Related Articles

Bosentan in heart transplantation candidates with severe pulmonary hypertension: efficacy, safety and outcome after transplantation.

Clin Transplant. 2012 Aug 2;

Authors: Perez-Villa F, Farrero M, Cardona M, Castel MA, Tatjer I, Penela D, Vallejos I

Abstract
BACKGROUND: Increased pulmonary vascular resistance (PVR) is associated with increased right ventricular failure and mortality after heart transplantation. METHODS: In this prospective study, 22 patients considered high-risk candidates for heart transplantation because of severe pulmonary hypertension (PVR = 6 ± 2 Wood units; transpulmonary gradient 22 ± 7 mmHg), received bosentan 125 mg bid. Right heart catheterization was repeated after four months (n = 22) and 12 months (n = 9). Eleven patients who declined participation in the study were considered as control group. RESULTS: After four months, PVR decreased by 38% in patients receiving bosentan (n = 22), while it increased by 25% in the control group (p = 0.001). Those patients who received bosentan for 12 months (n = 9), experienced a 60% reduction in PVR compared to baseline (p = 0.003). Only three patients (14%) had no hemodynamic improvement with bosentan. After bosentan therapy, 14 patients (64%) underwent heart transplantation. Patients with high PVR who received bosentan showed a trend toward better one-yr survival after transplantation than patients with PVR ≤ 2.5 Wood units transplanted in the same period of time (93% vs. 83%). CONCLUSIONS: In patients considered high-risk candidates for heart transplantation because of high PVR, therapy with bosentan is associated with a significant reduction in PVR and a good outcome after transplantation.

PMID: 22861120 [PubMed - as supplied by publisher]

Renal replacement therapy in congestive heart failure requiring left ventricular assist device augmentation.

Fri, 08/10/2012 - 19:07
Related Articles

Renal replacement therapy in congestive heart failure requiring left ventricular assist device augmentation.

Perit Dial Int. 2012 Jul;32(4):386-92

Authors: Thomas BA, Logar CM, Anderson AE

Abstract
"Cardiorenal syndrome" is a term used to describe a dys-regulation of the heart affecting the kidneys, or vice versa, in an acute or chronic manner (1,2). Renal impairment can range from reversible ischemic damage to renal failure requiring short- or long-term renal replacement therapy (2). Patients who require mechanical circulatory support, such as a left ventricular assist device (LVAD), as definitive treatment for congestive heart failure or as a bridge to cardiac transplantation pose a unique challenge with respect to receiving dialysis, because they experience higher rates of morbidity and mortality from infection in the post-LVAD period (3-7). Acute dialysis access can pose an increased infection risk. In this article, we present a patient who required renal replacement therapy and a LVAD for management of acute-on-chronic cardiorenal syndrome while awaiting heart transplantation. A literature review to determine whether peritoneal dialysis or hemodialysis is superior for patients with profound hemodynamic dysfunction and the need to minimize risk of infection did not offer clear guidance about which modality is superior in patients with advanced congestive heart failure. However, there is clear evidence of the superiority of peritoneal dialysis in reducing the risk of systemic infection secondary to acute dialysis access. Given the high risk of LVAD infection, we therefore conclude that, to decrease mortality secondary to systemic infection, peritoneal dialysis should strongly be considered in patients who require renal replacement therapy before or after LVAD placement.

PMID: 22859837 [PubMed - in process]

Rapid resolution of severe sustained low blood pressure in haemodialysis patients after successful renal transplantation.

Fri, 08/10/2012 - 19:07
Related Articles

Rapid resolution of severe sustained low blood pressure in haemodialysis patients after successful renal transplantation.

Nephrol Dial Transplant. 2012 Aug 1;

Authors: Muscroft L, Zehnder D, Fletcher S, Krishnan N, Watson D, Murthy B, Higgins R

Abstract
BackgroundLow blood pressure occurring in the absence of volume depletion, anti-hypertensive medication, heart failure or cortisol deficiency occurs in ∼5-10% of haemodialysis patients, and can result in serious complications. The pathophysiology of this syndrome is poorly understood.MethodsWe describe eight cases with dialysis-associated hypotension who underwent renal transplantation. Four patients were severely hypotensive with a systolic blood pressure (SBP) <100 mmHg before and during dialysis, and four had a SBP usually <100 mmHg during dialysis, but usually >100 mmHg between sessions. All had donor-specific human leukocyte antigen antibodies. Six patients underwent pre-transplant plasmapheresis, which was curtailed in two because of further falls in blood pressure. Two patients experienced clotting of their arteriovenous fistula. In one patient cryofiltration was used, which was tolerated without severe falls in the BP. The remaining patient, who had hypotension-associated retinal vein thrombosis before transplant, was supported with an epinephrine infusion and did not receive plasmapheresis.ResultsPost-transplant, the first patient did not receive pressor therapy and died from bowel ischaemia. The other seven patients were supported with inotropes on critical care. The administration of steroids did not reverse hypotension. The mean pre-treatment SBP was 96 mmHg (range 71-110, SEM 5.0). After inotropes were withdrawn and graft function was established, the mean SBP was 127 mmHg (range 113-149, SEM 4.9) (P < 0.01).ConclusionsRenal transplantation was performed successfully and safely in patients when pressor therapy was used to treat severe dialysis-associated hypotension and, moreover, the blood pressure normalized rapidly after graft function was established.

PMID: 22859790 [PubMed - as supplied by publisher]

Transplantation of bone marrow-derived endothelial progenitor cells attenuates myocardial interstitial fibrosis and cardiac dysfunction in streptozotocin-induced diabetic rats.

Fri, 08/10/2012 - 19:07
Related Articles

Transplantation of bone marrow-derived endothelial progenitor cells attenuates myocardial interstitial fibrosis and cardiac dysfunction in streptozotocin-induced diabetic rats.

Int J Mol Med. 2012 Jul 31;

Authors: Cheng Y, Guo S, Liu G, Feng Y, Yan B, Yu J, Feng K, Li Z

Abstract
Diabetic cardiomyopathy (DCM) is a progressive disease of the heart muscle and the third most common cause of heart failure. In the present study, we evaluated the effects of bone marrow‑derived endothelial progenitor cell (EPC) transplantation on the development of DCM in a streptozotocin (STZ)-induced diabetic rat model. Ex vivo generated, characterized and cultivated rat EPCs were identified by flow cytometry of their surface markers. EPCs were transplanted intravenously into rats through the tail vein 6 weeks after they were challenged with STZ and the rats were sacrificed 4 weeks later. Before sacrifice, left ventricular (LV) catheterization was performed to evaluate the cardiac function. Myocardium sections were stained with Masson's trichrome staining to investigate myocardial collagen contents. Fibrosis-, apoptosis- and oxidative stress-related gene expressions were analyzed by western blot analysis. Transplantation of EPCs alleviated the impaired cardiac function associated with diabetes and decreased the collagen volume in diabetic myocardium resulting in improved cardiac function. Furthermore, EPC transplantation decreased the expression of type I collagen, Bax, caspase-3 and p67phox, while increasing the expression of Bcl-2 and manganese superoxide dismutase (MnSOD). Taken together, our results suggest that transplantation of EPCs improved cardiac function in the rat DCM model, likely through inhibition of cardiomyocyte apoptosis and attenuating myocardial fibrosis.

PMID: 22859217 [PubMed - as supplied by publisher]

Summary of the II Brazilian Guideline Update on Acute Heart Failure 2009/2011.

Fri, 08/10/2012 - 19:07
Related Articles

Summary of the II Brazilian Guideline Update on Acute Heart Failure 2009/2011.

Arq Bras Cardiol. 2012 May;98(5):375-383

Authors: Montera MW, Pereira SB, Colafranceschi AS, Almeida DR, Tinoco EM, Rocha RM, Moura LA, Réa-Neto A, Mangini S, Braga FG, Albuquerque DC, Stefanini E, Saad EB, Vilas-Boas F

Abstract
In the past two years we observed several changes in the diagnostic and therapeutic approach of patients with acute heart failure (acute HF), which led us to the need of performing a summary update of the II Brazilian Guidelines on Acute Heart Failure 2009. In the diagnostic evaluation, the diagnostic flowchart was simplified and the role of clinical assessment and echocardiography was enhanced. In the clinical-hemodynamic evaluation on admission, the hemodynamic echocardiography gained prominence as an aid to define this condition in patients with acute HF in the emergency room. In the prognostic evaluation, the role of biomarkers was better established and the criteria and prognostic value of the cardiorenal syndrome was better defined. The therapeutic approach flowcharts were revised, and are now simpler and more objective. Among the advances in drug therapy, the safety and importance of the maintenance or introduction of beta-blockers in the admission treatment are highlighted. Anticoagulation, according to new evidence, gained a wider range of indications. The presentation hemodynamic models of acute pulmonary edema were well established, with their different therapeutic approaches, as well as new levels of indication and evidence. In the surgical treatment of acute HF, CABG, the approach to mechanical lesions and heart transplantation were reviewed and updated. This update strengthens the II Brazilian Guidelines on Acute Heart Failure to keep it updated and refreshed. All clinical cardiologists who deal with patients with acute HF will find, in the guidelines and its summary, important tools to help them with the clinical practice for better diagnosis and treatment of their patients.

PMID: 22858653 [PubMed - as supplied by publisher]

Outcomes of the HeartWare Ventricular Assist System support in 141 patients: a single-centre experience.

Fri, 08/10/2012 - 19:07
Related Articles

Outcomes of the HeartWare Ventricular Assist System support in 141 patients: a single-centre experience.

Eur J Cardiothorac Surg. 2012 Aug 1;

Authors: Wu L, Weng YG, Dong NG, Krabatch T, Potapov EV, Stepanenko A, Hennig E, Hetzer R

Abstract
OBJECTIVES: A third-generation ventricular assist device, the HeartWare Ventricular Assist System, has demonstrated its reliability and durability in animal models and clinical experience. However, studies of a large series of applications are still lacking. We evaluate the safety and efficacy of the HeartWare pump in 141 patients with end-stage heart failure at a single centre. METHODS: A total of 141 patients (116 men and 25 women with a mean age of 52 years) in New York Heart Association (NYHA) Class IV received implantation of the HeartWare Ventricular Assist System between August 2009 and April 2011. The outcomes were measured in terms of laboratory data, adverse events, NYHA functional class and survival during device support. RESULTS: The HeartWare system provided an adequate haemodynamic support for patients both inside and outside the hospital. NYHA class improved to I-II. Organ function and pulmonary vascular resistance improved significantly. In this cohort of patients, 14 patients underwent heart transplantation, one had had the device explanted following myocardial recovery, one had changed to another assist device, 81 were on ongoing support and 44 died. The overall actuarial survival rates at 6 and 12 months were 70 and 67%, respectively, and the 3-, 6- and 12-month survival rates on a left ventricular assist device (LVAD) support for bridge to transplantation patients were 82, 81 and 79%, respectively. There were no statistically significant differences between the three age groups (P = 0.307). Support with an LVAD showed a better survival than with a biventricular assist device (BVAD) (P = 0.021). Infection and bleeding were the main adverse events. Four patients underwent an LVAD exchange for pump thrombosis. The early mortality (device support ≤30 days) was 59% (26/44 patients). The major cause was right ventricular failure. CONCLUSIONS: The HeartWare system provides a safe and effective circulatory support in a population with a wide range of body surface areas, with a satisfactory actuarial survival time and an improved quality of life. It can be used for univentricular or biventricular support, being implanted into the pericardial space with simplified surgical techniques.

PMID: 22858453 [PubMed - as supplied by publisher]

Should Patients 60 Years and Older Undergo Bridge to Transplantation With Continuous-Flow Left Ventricular Assist Devices?

Fri, 08/10/2012 - 19:07
Related Articles

Should Patients 60 Years and Older Undergo Bridge to Transplantation With Continuous-Flow Left Ventricular Assist Devices?

Ann Thorac Surg. 2012 Aug 1;

Authors: Allen JG, Kilic A, Weiss ES, Arnaoutakis GJ, George TJ, Shah AS, Conte JV

Abstract
BACKGROUND: Although left ventricular assist devices (LVADs) are now commonly used as a bridge to orthotopic heart transplantation (OHT), the upper patient age limit for this therapy has not been defined. Smaller studies have suggested that advanced age should not be a contraindication to bridge to transplantation (BTT) LVAD placement. The purpose of this study was to examine outcomes in patients 60 years and older undergoing BTT with continuous-flow LVADs. METHODS: The United Network for Organ Sharing (UNOS) database was reviewed to identify first-time OHT recipients 60 years of age and older (2005-2010). Patients were stratified by preoperative support: continuous-flow LVAD, intravenous inotropic agents, and direct transplantation. Survival after OHT was modeled using the Kaplan-Meier method. All-cause mortality was examined using multivariable Cox proportional hazard regression. RESULTS: Of 2,554 patients, 1,142 (44.7%) underwent direct transplantation, 264 (10.3%) had LVAD BTT, and 1,148 (45.0%) had BTT with inotropic agents. The mean age was 64 ± 3 years, and 460 (18.0%) patients were women. Mean follow-up was 29 ± 19 months. Survival differed significantly among the 3 groups. Patients with LVAD BTT had significantly lower survival after OHT compared with the other groups at 30 days and 1 year. This survival difference was no longer significant at 2 years after OHT or when deaths in the first 30 days were censored. LVAD BTT increased the hazard of death at 1 year by 50% (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.05-2.15; p = 0.03), compared with patients who underwent direct transplantation. CONCLUSIONS: This study represents the largest modern cohort in which survival after OHT has been evaluated in patients 60 years or older who received BTT. Older patients have lower short-term survival after OHT when BTT is carried out with a continuous-flow LVAD compared with inotropic agents or direct transplantation.

PMID: 22858277 [PubMed - as supplied by publisher]

Stable Ventricular Fibrillation in a Heterotopic Heart Transplant Recipient.

Fri, 08/10/2012 - 19:07
Related Articles

Stable Ventricular Fibrillation in a Heterotopic Heart Transplant Recipient.

Heart Lung Circ. 2012 Aug 1;

Authors: Secco GG, Bortnik M, Rognoni A, Lupi A, Cavallino C, De Luca G, Marino PN

Abstract
We present an unusual case of ventricular fibrillation in a conscious patient symptomatic for chest pain and shortness of breath. Almost 20years ago he underwent heterotopic cardiac transplantation for the treatment of severe idiopathic cardiomyopathy. In the precyclosporine era, this technique was extremely useful because of the high rate of graft rejection in which the maintenance of the native heart could prevent patient death. To date, with the improvements in immunosuppressive therapy, it is generally reserved to a specific subset of conditions. A coronary angiography and a cardiac MRI confirmed the diagnosis. Six months follow-up ECG was unchanged suggesting the persistence of a double heart rhythm in the same body.

PMID: 22858206 [PubMed - as supplied by publisher]

Zygomycosis over-infection during voriconazole therapy for aspergillosis in a heart transplant patient, successfully treated with liposomal amphotericin and posaconazole.

Fri, 08/10/2012 - 19:07
Related Articles

Zygomycosis over-infection during voriconazole therapy for aspergillosis in a heart transplant patient, successfully treated with liposomal amphotericin and posaconazole.

Transpl Infect Dis. 2012 Jul 31;

Authors: Bourke P, Castro P, Rabagliati R, Beltran C, Verdejo H, Winter JL, Bourge RC

Abstract
Aspergillosis and zygomycosis are life-threatening fungal infections in immunocompromised patients. We report a heart transplant recipient with an early pulmonary invasive aspergillosis successfully treated with association of voriconazole and caspofungin. Zygomycosis sinusitis, which was diagnosed while he still was on voriconazole therapy, was successfully treated with the use of combination antifungal therapy including liposomal amphotericin plus posaconazole and conservative surgical debridement.

PMID: 22852999 [PubMed - as supplied by publisher]

Prognostic factors of mid-term clinical outcome in congestive heart failure patients discharged after acute decompensation.

Fri, 08/10/2012 - 19:07
Related Articles

Prognostic factors of mid-term clinical outcome in congestive heart failure patients discharged after acute decompensation.

Arch Med Sci. 2012 Jul 4;8(3):462-70

Authors: Feola M, Lombardo E, Testa M, Avogadri E, Piccolo S, Vado A

Abstract
INTRODUCTION: Risk stratification in congestive heart failure (CHF) patients is based on a variety of clinical and laboratory variables. We analysed renal function, BNP, water composition, echocardiographic and functional determinations in predicting mid-term outcome in CHF patients discharged after decompensation.
MATERIAL AND METHODS: All subjects with NYHA class II-IV were enrolled at hospital discharge. NYHA class, BNP, water body composition, non-invasive cardiac output and echocardiogram were analysed. Death, cardiac transplantation and hospital readmission for CHF were scheduled.
RESULTS: Two-hundred and thirty-seven (64.5% males, age 71.1±10.1) patients were discharged after obtaining normal hydration; left ventricular ejection fraction (LVEF) was 43.2±16.2%, cardiac output was 3.8±1.1 l/min and BNP at discharge resulted 401.3±501.7 pg/ml. During the 14-month follow-up 15 patients (6.3%) died, 1 (0.4%) underwent cardiac transplantation and 18 (7.6%) were readmitted for CHF (event group); in 203 (85.6%) no events were observed (no-event group). Higher NYHA class (2.1±0.7 vs. 1.9±0.4, p=0.01), BNP at discharge (750.2±527.3 pg/ml vs. 340.7±474.3 pg/ml, p=0.002) and impaired LVEF (33.7±15.7% vs. 44.5±15.8%, p=0.0001) and creatinine (1.7±0.6 vs. 1.2±0.8 mg/dl, p=0.004) were noticed in the event group. At multivariate Cox analysis LVEF (p=0.0009), plasma creatinine (p=0.006) and BNP at discharge (p=0.001) were associated with adverse mid-term outcome. Kaplan-Meier survival curves demonstrated that adding cut-off points for creatinine 1.5 mg/dl and discharged BNP of 250 pg/ml discriminated significantly prognosis (p=0.0001; log rank 21.09).
CONCLUSIONS: In predicting mid-term clinical prognosis in CHF patients discharged after acute decompensation, BNP at discharge ≥ 250 pg/ml added with plasma creatinine > 1.5 mg/dl are strong adverse predictors.

PMID: 22852001 [PubMed - in process]

Successful extracorporeal membrane oxygenation weaning after cardiac resynchronization therapy device implantation in a patient with end-stage heart failure.

Fri, 08/10/2012 - 19:07
Related Articles

Successful extracorporeal membrane oxygenation weaning after cardiac resynchronization therapy device implantation in a patient with end-stage heart failure.

Interact Cardiovasc Thorac Surg. 2012 Jul 30;

Authors: Pecha S, Yildirim Y, Reichenspurner H, Deuse T

Abstract
We present the case of a 46-year old male with end-stage heart failure due to ethyltoxic cardiomyopathy. The patient did not meet the criteria for heart transplantation and declined left ventricular assist device implantation. We decided to conduct cardiac resynchronization therapy defibrillator (CRT-D) implantation. Under general anaesthesia for CRT-D implantation, cardiac function worsened. Due to deteriorating haemodynamics, CRT-D implantation was aborted and emergent veno-arterial extracorporeal membrane oxygenation (ECMO) implantation was performed. Subsequent weaning from ECMO was not possible. We decided to proceed with CRT-D implantation while still on ECMO support. With biventricular stimulation, cardiac function improved promptly and the patient could be weaned from ECMO the same day.

PMID: 22851758 [PubMed - as supplied by publisher]

Tracking Chromatid Segregation to Identify Human Cardiac Stem Cells that Regenerate Extensively the Infarcted Myocardium.

Fri, 08/10/2012 - 19:07
Related Articles

Tracking Chromatid Segregation to Identify Human Cardiac Stem Cells that Regenerate Extensively the Infarcted Myocardium.

Circ Res. 2012 Jul 31;

Authors: Kajstura J, Bai Y, Cappetta D, Kim J, Arranto C, Sanada F, D'Amario D, Matsuda A, Bardelli S, Ferreira-Martins J, Hosoda T, Leri A, Rota M, Loscalzo J, Anversa P

Abstract
Rationale: According to the immortal DNA strand hypothesis, dividing stem cells selectively segregate chromosomes carrying the old template DNA, opposing accumulation of mutations resulting from non-repaired replication errors and attenuating telomere shortening. Objective: Based on the premise of the immortal DNA strand hypothesis, we propose that stem cells retaining the old DNA would represent the most powerful cells for myocardial regeneration. Methods and Results: Division of hCSCs by non-random and random segregation of chromatids was documented by clonal assay of bromodeoxyuridine-tagged hCSCs. Additionally, their growth properties were determined by a series of in vitro and in vivo studies. We report that a small class of hCSCs retain during replication the mother DNA and generate two daughter cells, which carry the old and new DNA, respectively. hCSCs with immortal DNA form a pool of non-senescent cells with longer telomeres and higher proliferative capacity. The self-renewal and long-term repopulating ability of these cells was shown in serial-transplantation assays in the infarcted heart; these cells created a chimeric organ, composed of spared rat and regenerated human cardiomyocytes and coronary vessels, leading to a remarkable restoration of cardiac structure and function. The documentation that hCSCs divide by asymmetric and symmetric chromatid segregation supports the view that the human heart is a self-renewing organ regulated by a compartment of resident hCSCs. Conclusions: The impressive recovery in ventricular hemodynamics and anatomy mediated by clonal hCSCs carrying the "mother" DNA underscores the clinical relevance of this stem cell class for the management of heart failure in humans.

PMID: 22851539 [PubMed - as supplied by publisher]

T-cell therapy for viral infections following transplantation: why stop at three viruses?

Fri, 08/10/2012 - 19:07
Related Articles

T-cell therapy for viral infections following transplantation: why stop at three viruses?

Mol Ther. 2012 Aug;20(8):1487-8

Authors: Barrett JA

PMID: 22850720 [PubMed - in process]

Pages