RESUMEN
The objective of this study was to analyse the prevalence and characteristics of the main clinical and immunological manifestations at the onset and during the evolution of the disease in a cohort of patients from Latin America (mainly of mestizo origin) and to compare the Latin American with the European patients. Clinical and serological characteristics of 100 APS patients from Mexico and Ecuador were collected in a protocol form that was identical to that used to study the ;Euro-Phospholipid' cohort. The cohort consisted of 93 female patients (93.0%) and seven (7.0%) male patients. There were 91 mestizos (91.0%), seven whites (7.0%) and two Amerindians (2.0%). The most common manifestations were livedo reticularis (40.0%), migraine (35.0%), inferior extremity deep vein thrombosis (32.0%), thrombocytopenia (28.0%) and hemolytic anemia (20.0%). Several clinical manifestations were more prevalent in Latin American than in European patients and they included mainly neurological (migraine, transient global amnesia, acute ischemic encephalopathy, amaurosis fugax) and cutaneous (livedo reticularis, skin ulcerations, superficial cutaneous necrosis, multiple subungual splinter hemorrhages) manifestations as well as hemolytic anemia. The APS has a wide variety of clinical and immunological manifestations at the onset and during the evolution of the disease and the ethnic origin in addition to environmental and socioeconomic factors can modify the disease expression.
Asunto(s)
Síndrome Antifosfolípido/epidemiología , Síndrome Antifosfolípido/inmunología , Adolescente , Adulto , Anciano , Síndrome Antifosfolípido/patología , Niño , Estudios de Cohortes , Ecuador/epidemiología , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana EdadRESUMEN
BACKGROUND: Because of the critical shortage of adult donor hearts, many recipients die awaiting transplantation of an organ of appropriate size. Undersized hearts (donor/recipient weight ratio < 0.7) have been used for heterotopic heart transplantation. We report on 6 moribund adult heart transplant candidates who were rescued with orthotopic heart transplantation of undersized pediatric hearts. METHODS AND RESULTS: Recipients were hypotensive (mean blood pressure, 62.3 +/- 13.4 mm Hg), had high pulmonary artery pressures (mean pulmonary artery pressure, 42.4 +/- 6.3 mm Hg), and had mean cardiac indexes of 1.7 +/- 0.6 L.min-1.m-2. Four had pretransplant intra-aortic balloon pumps, and one was on a Thoratec left ventricular assist device complicated by fungemia. Since conventionally sized donors were unavailable (+/- 30% recipient weight), the patients were listed in a wider weight range (+/- 60%). Donor characteristics were age, 8.7 +/- 1.5 years; weight, 32.8 +/- 7.0 kg; and donor/recipient weight ratio, 0.44 +/- 0.2, with average ischemic time of 236.0 +/- 59.3 minutes. Technical considerations during transplantation included (1) opening the donor right atrium from the inferior vena cava to superior vena cava to facilitate size matching, (2) performing size-mismatched pulmonary artery and aortic anastomoses end to end, (3) infusing prostaglandin E1 12 ng.kg-1.min-1 to decrease pulmonary and systemic vascular resistance, (4) pacing donor and recipient atria synchronously to improve ventricular filling, (5) maintaining high heart rates up to 140 beats per minute (initially with isoproterenol or pacing, chronically with theophylline), (6) hyperventilating with sedation and paralysis as necessary, (7) reperfusing with triiodothyronine, and (8) minimizing afterload. All patients were discharged from the hospital. At 1 week, hemodynamics were normal and echocardiograms demonstrated left ventricular growth. CONCLUSIONS: Hence, undersized pediatric hearts can be used successfully to salvage moribund patients and expand the potential donor pool for adult orthotopic heart transplantation.
Asunto(s)
Trasplante de Corazón/métodos , Donantes de Tejidos , Constitución Corporal , Niño , Cuidados Críticos , Femenino , Corazón/anatomía & histología , Trasplante de Corazón/fisiología , Humanos , Terapia de Inmunosupresión , Contrapulsador Intraaórtico , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Estudios ProspectivosRESUMEN
Orthotopic heart transplantation was performed in a 65-year-old man with a donor heart with Wolff-Parkinson-White Syndrome. An electrophysiologic study performed 7 days after transplantation showed a left-lateral accessory pathway that exhibited only anterograde conduction. Radiofrequency ablation of the bypass tract was successfully performed, and no evidence of recurrence was found at 12 months' follow-up. We suggest that potential donors with known electrophysiologic abnormalities that are amenable to catheter ablation techniques should be considered for orthotopic heart transplantation, thus broadening the potential donor pool.