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Cardiac transplant complication

Veysel Tosun, Necmettin Korucuk, Unal Guntekin
Sinus of valsalva aneurysm (SVA) is a rare cardiac disease. The most common complication of SVA is rupture into the right atrium or right ventricle. Rupture into the left chambers is very rare. Patients with ruptured SVA are likely to die of heart failure or endocarditis. We present a 29-year-old man who was hospitalized for hepatic transplantation with rupture of SVA. Transthoracic echocardiography and transesophageal echocardiography showed rupture of a noncoronary SVA into the left atrium. Mitral valve infective endocarditis developed and surgery was planned for the patient, but the patient died due to multiple organ dysfunction syndrome...
April 2018: Journal of Cardiovascular Echography
David Ouyang, Gunsagar Gulati, Richard Ha, Dipanjan Banerjee
BACKGROUND: Proposed changes to the United Network for Organ Sharing heart transplant allocation protocol will prioritize patients receiving temporary mechanical circulatory support (tMCS), including extracorporeal membrane oxygenation (ECMO), percutaneous ventricular assist devices (PVADs), and intra-aortic balloon pumps (IABPs). We sought to evaluate contemporary trends in the incidence and outcomes of patients who required tMCS during the hospitalization before heart transplantation...
April 26, 2018: Journal of Heart and Lung Transplantation
Sabina Pw Guenther, Yasuhiro Shudo, William Hiesinger, Dipanjan Banerjee
OBJECTIVES: In intractable cardiogenic shock, extracorporeal life support frequently is the last treatment option. Outcomes of prolonged veno-arterial extracorporeal life support for cardiac failure are poorly defined. METHODS: We retrospectively analyzed 10 patients (4 females, age = 36 ± 16 years) who underwent prolonged extracorporeal life support (≥7 days) from December 2015 to March 2017 for cardiogenic shock. The primary endpoint was survival to hospital discharge...
June 1, 2018: International Journal of Artificial Organs
Charles D Fraser, Joshua C Grimm, Rui Han Liu, Russell N Wesson, Faris Azar, Robert J Beaulieu, Thomas Reifsnyder
INTRODUCTION: Renal transplant recipients often maintain their hemodialysis access in the event of future allograft failure. Patients may develop complications related to the unused dialysis access and it also limits vein availability for phlebotomy. Accordingly, a change in the current paradigm may be warranted. This study evaluates the indications for, and safety of, arteriovenous fistula (AVF) removal in patients following successful renal transplantation. METHODS: All patients that underwent AVF excision at a single institution from 2006-2016 were retrospectively reviewed...
June 7, 2018: Annals of Vascular Surgery
Trevor Birkey, Jennifer Dixon, Roni Jacobsen, Salil Ginde, Melodee Nugent, Ke Yan, Pippa Simpson, Joshua Kovach
Adult congenital heart disease (ACHD) patients often require repeat cardiothoracic surgery, which may result in significant morbidity and mortality. Currently, there are few pre-operative risk assessment tools available. In the general adult population, pre-operative cardiopulmonary exercise testing (CPET) has a predictive value for post-operative morbidity and mortality following major non-cardiac surgery. The utility of CPET for risk assessment in ACHD patients requiring cardiothoracic surgery has not been evaluated...
June 7, 2018: Pediatric Cardiology
S-L Pai, S Aniskevich, I I Logvinov, G V Matcha, W C Palmer, J L Blackshear
BACKGROUND: Hypertrophic cardiomyopathy (HCM) is an autosomal dominant disorder that presents with a hypertrophied nondilated left ventricle. In the absence of other known causes of cardiomyopathy, it is often associated with left ventricular outflow tract obstruction during systole, systolic anterior motion of the mitral valve, mitral regurgitation, and increased risk of sudden cardiac death. When HCM coexists with end-stage liver disease, it can be further complicated by cirrhosis-associated cardiovascular abnormalities, including hyperdynamic circulation, systolic and diastolic dysfunction, and electrophysiologic abnormalities...
June 2018: Transplantation Proceedings
Marjolein C Persoon, Olivier C Manintveld, Femke P N Mollema, Jaap J van Hellemond
Introduction: Chagas disease is caused by infection with the protozoan Trypanosoma cruzi. It is endemic to the American continent due to the distribution of its insect vectors. The disease is occasionally imported to other continents by travel of infected individuals. It is rarely diagnosed in the Netherlands and exact numbers of infected individuals are unknown. Clinical manifestations can start with an acute phase of 4-8 weeks with non-specific, mild symptoms and febrile illness. In the chronic phase, it can lead to fatal cardiac and gastro-intestinal complications...
April 2018: JMM Case Reports
Alonso Turrent-Carriles, Juan Pablo Herrera-Félix, Mary-Carmen Amigo
Antiphospholipid syndrome is a complex autoimmune disease, characterized by the presence of vascular thrombosis, obstetric, hematologic, cutaneous, and cardiac manifestations. Renal disease in patients with antiphospholipid syndrome was not recognized in the first descriptions of the disease, but later on, the renal manifestations of the syndrome have been investigated widely. Renal manifestations of antiphospholipid syndrome conform a wide spectrum of diverse renal syndromes. Hypertension is one of the most frequent, but less commonly recognized renal alteration...
2018: Frontiers in Immunology
Dharma Budi Sunjaya, Guilherme Piovezani Ramos, Manuel Bonfim Braga Neto, Ryan Lennon, Taofic Mounajjed, Vijay Shah, Patrick Sequeira Kamath, Douglas Alano Simonetto
AIM: To characterize isolated non-obstructive sinusoidal dilatation (SD) by identifying associated conditions, laboratory findings, and histological patterns. METHODS: Retrospectively reviewed 491 patients with SD between 1995 and 2015. Patients with obstruction at the level of the small/large hepatic veins, portal veins, or right-sided heart failure were excluded along with history of cirrhosis, hepatic malignancy, liver transplant, or absence of electrocardiogram/cardiac echocardiogram...
May 27, 2018: World Journal of Hepatology
Víctor Rossel, Rodrigo Díaz, Lorenzo Merello, Ernesto Aranguiz-Santander, Aleck Stockins, Gabriel Olivares
There has been a progressive increase in the use of mechanical circulatory support in our country in the last years, mainly in the short-term: as a bridge to cardiac transplant or recovery, which has allowed to rescue patients from a population that concentrates high rates of complications and mortality. This motivated that the Ministry of Health convened a series of experts in the area of heart failure, transplantation and mechanical circulatory support, representatives of different public and private health centers in Chile, with the objective of developing recommendations on the use of short-term mechanical assistance devices, which would serve as a reference for the proper management of these patients...
January 2018: Revista Médica de Chile
László Szudi, László Székely, Erzsébet Sápi, Zsolt Prodán, Jenő Szolnoky, Ákos Csomós, Noémi Nyolczas, Erzsébet Paulovich, Endre Németh, István Hartyánszky, Endre Zima, Balázs Sax, Andrea Bertalan, László Hejjel, Gábor Bogáts, Barna Babik, Károly Gombocz, Tamás Szerafin, György Koszta, Andrea Molnár
Low output syndrome significantly increases morbidity and mortality of cardiac surgery and lengthens the durations of intensive care unit and hospital stays. Its treatment by catecholamines can lead to undesirable systemic and cardiac complications. Levosimendan is a calcium sensitiser and adenosine triphosphate (ATP)-sensitive potassium channel (IK,ATP ) opener agent. Due to these effects, it improves myocardium performance, does not influence adversely the balance between O2 supply and demand, and possesses cardioprotective and organ protective properties as well...
June 2018: Orvosi Hetilap
Marina Gitman, Megan Albertz, Ramona Nicolau-Raducu, Stephen Aniskevich, Sher-Lu Pai
Improvements in early survival after liver transplant (LT) have allowed for the selection of LT candidates with multiple comorbidities. Cardiovascular disease is a major contributor to post-LT complications. We performed a literature search to identify the causes of cardiac disease in the LT population and to describe techniques for diagnosis and perioperative management. Since no definite guidelines for preoperative assessment (except for pulmonary heart disease) are currently available, we recommend an algorithm for preoperative cardiac work-up...
May 27, 2018: Clinical Transplantation
Rebecca Cogswell, Sue Duval, Ranjit John
BACKGROUND: Left ventricular assist device (LVAD) related complications have the potential to disqualify patients for heart transplantation. We sought to determine whether LVAD support was associated with increased rates of delisting due to medical unsuitability or clinical deterioration. METHODS: The analysis included adult candidates listed for first-time heart transplantation in the UNOS registry in the contemporary, continuous flow (CF)- LVAD era (2010-2016)...
May 9, 2018: International Journal of Cardiology
Rabea Asleh, Megha Prasad, Alexandros Briasoulis, Valentina Nardi, Rosalyn Adigun, Brooks S Edwards, Naveen L Pereira, Richard C Daly, Amir Lerman, Sudhir S Kushwaha
BACKGROUND: Cardiac allograft vasculopathy (CAV) is a major complication after heart transplantation (HT). Uric acid (UA) may play a role in CAV due to its role in stimulating T-cell-mediated immunity. Sirolimus is associated with CAV attenuation through a number of mechanisms, including immune-mediated effects. We aimed to determine whether UA is an independent predictor of CAV and whether conversion to sirolimus as primary immunosuppression modulates UA levels. METHODS: We retrospectively analyzed a cohort of 224 patients who underwent HT between 2004 and 2015 and had serial coronary intravascular ultrasound (IVUS) studies...
May 1, 2018: Journal of Heart and Lung Transplantation
Julien Regamey, Matthias Kirsch, Piergiorgio Tozzi, Nicolas Barras, Carlo Marcucci, Lucas Liaudet, Roger Hullin, Patrick Yerly
Despite the benefit of the drugs acting on neuro-humoral activation and cardiac resynchronization therapy, some patients will end in a severe refractory form of heart failure: advanced heart failure. The only therapeutic options with a positive impact on mortality and quality of life are heart transplantation and permanent left ventricular assist device (LVAD). The significant technological improvements of the past 20 years lead to a reduction of the complications associated with these devices, which now allow their use not only during the waiting period preceding heart transplantation (bridge to transplant), but also as a durable therapeutic option (destination therapy)...
May 23, 2018: Revue Médicale Suisse
Emma J Sharkey, Costanzo Di Maria, Annette Klinge, Alan Murray, Dingchang Zheng, John O'Sullivan, John Allen
OBJECTIVE: It has been documented that heart transplantation in children is often complicated by arterial hypertension and increased arterial stiffness. AIM: to use innovative multi-site photoplethysmography (MPPG) pulse measurement and analysis technology to assess arterial stiffness change in paediatric heart transplant recipients (HTR) in comparison with healthy control (HC) children. 
 Approach: 20 heart transplant (median age 13.5 years old) (8 male) recipients were compared to an overall age- and gender-matched group of 161 healthy controls (11...
May 23, 2018: Physiological Measurement
David Prieto, Pedro M Correia, Manuel Batista, Manuel J Antunes
OBJECTIVES: Primary graft failure (PGF) is a common and devastating complication, despite the advances in perioperative treatment. We aim to evaluate the prevalence of PGF and its impact on survival and to explore associated risk factors. METHODS: From November 2003 through December 2015, 290 patients submitted to cardiac transplantation were classified into non-PGF (243; 84%) and PGF (47; 16%) groups. The characteristics of the recipients were similar regarding age (54...
May 19, 2018: Interactive Cardiovascular and Thoracic Surgery
Daniel Miklin, Ivy Lewis, Howard Lieberman
BACKGROUND: Left ventricular assist devices (LVAD) provide a lifesaving bridge to cardiac transplant. Utilization of these devices is increasing in the United States. When a patient undergoes cardiac transplant, the left ventricular device is surgically removed and the driveline is extracted or left tunneled in the subcutaneous tissue. Our group encountered a rare and previously unreported complication of this device: intraperitoneal infiltration of a retained driveline after cardiac transplant causing a small bowel obstruction...
May 21, 2018: Journal of Cardiothoracic Surgery
Enrico Ammirati, Manlio Cipriani, Claudio Moro, Claudia Raineri, Daniela Pini, Paola Sormani, Riccardo Mantovani, Marisa Varrenti, Patrizia Pedrotti, Cristina Conca, Antonio Mafrici, Aurelia Grosu, Daniele Briguglia, Silvia Guglielmetto, Giovanni Battista Perego, Stefania Colombo, Salvatore Ivan Caico, Cristina Giannattasio, Alberto Maestroni, Valentina Carubelli, Marco Metra, Carlo Lombardi, Jeness Campodonico, Piergiuseppe Agostoni, Giovanni Peretto, Laura Scelsi, Annalisa Turco, Giuseppe Di Tano, Carlo Campana, Armando Belloni, Fabrizio Morandi, Andrea Mortara, Antonio Cirò, Michele Senni, Antonello Gavazzi, Maria Frigerio, Fabrizio Oliva, Paolo G Camici
Background -There is controversy regarding outcome of patients with acute myocarditis (AM), and lack of data on how patients admitted with suspected AM are managed. We report characteristics, in-hospital management and long-term outcome of patients with AM based on a retrospective multi-center registry from 19 Italian hospitals. Methods -A total of 684 patients with suspected AM and recent onset of symptoms (<30 days) were screened between May 2001 and February 2017. Patients >70 years and those older than 50 years without coronary angiography were excluded...
May 15, 2018: Circulation
Yosuke Saragai, Akinobu Takaki, Yuzo Umeda, Takashi Matsusaki, Tetsuya Yasunaka, Atsushi Oyama, Ryuji Kaku, Kazufumi Nakamura, Ryuichi Yoshida, Daisuke Nobuoka, Takashi Kuise, Kosei Takagi, Takuya Adachi, Nozomu Wada, Yasuto Takeuchi, Kazuko Koike, Fusao Ikeda, Hideki Onishi, Hidenori Shiraha, Shinichiro Nakamura, Hiroshi Morimatsu, Hiroshi Ito, Toshiyoshi Fujiwara, Takahito Yagi, Hiroyuki Okada
BACKGROUND: Portopulmonary hypertension (POPH) is characterized by pulmonary vasoconstriction, while hepatopulmonary syndrome (HPS) is characterized by vasodilation. Definite POPH is a risk factor for the survival after orthotopic liver transplantation (OLT), as the congestive pressure affects the grafted liver, while subclinical pulmonary hypertension (PH) has been acknowledged as a non-risk factor for deceased donor OLT. Given that PH measurement requires cardiac catheterization, the tricuspid regurgitation pressure gradient (TRPG) measured by echocardiography is used to screen for PH and congestive pressure to the liver...
May 15, 2018: BMC Gastroenterology
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