RESUMEN
PURPOSE: To describe the indications and outcomes for pediatric patients and patients with congenital heart disease (CHD) undergoing heart transplantation (HT) in New Zealand. METHODS: A retrospective audit of 253 patients who underwent HT from 1987 to end 2012 was undertaken. Thirty-seven patients were subdivided into two groups, those aged <18 years--pediatric heart disease (PHD) and those with CHD. Six patients aged <18 years were included in both the analyses. Demographic and clinical information were collected and outcomes established. RESULTS: Overall actuarial survival of 37 patients with PHD or CHD was 92% at one year, 85% at five years, and 52% at ten years. The PHD group comprised 22 (8.7%) patients, median age 14 years (range 6-17), 14 (64%) male, with cardiomyopathy in 13, CHD in 6, and rheumatic heart disease in 3. At follow-up, 11 patients had died. Actuarial survival was 91% at one year and 79% at five years. Of the four patients with a mechanical assist device to bridge, three were transplanted and alive at follow-up. The CHD group comprised 21 (8.3%) patients, median age 25 years (range 6-48) and 19 (90%) were male. At follow-up, three patients had died. Actuarial survival was 95% at one year, 94% at five years, and 85% at ten years. All five patients with pre-HT Fontan circulation were alive a median of eight years following HT. CONCLUSION: Heart transplantation for carefully selected pediatric patients and patients with CHD can be successfully performed with favorable outcomes in a geographically isolated unit.
Asunto(s)
Cardiopatías Congénitas/cirugía , Trasplante de Corazón , Cardiopatía Reumática/cirugía , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: Disparities in health care access and outcomes between Maori (M) and Non-Maori (NM) New Zealanders have been reported but little is known about access to and outcomes following heart transplantation (HT). METHODS: A retrospective analysis was performed of M and NM who underwent HT in New Zealand. Demographic, clinical and outcome data were collected. RESULTS: Of 253 patients transplanted, 176 were European, 47 M (19%) and 30 of other ethnicities. M and NM groups were compared. Median age (both 46 years), gender (17% vs 21% female), waiting time (90 vs 76 days) and diagnosis (dilated cardiomyopathy - 62% vs 58%) were similar for both groups. M were heavier (81 vs 71 kg, p<0.0001) and more were blood group A (58% vs 39%). Five year survival was similar (79% vs 78%) but 10 year survival was significantly reduced in M (54% vs 67% p=0.02). CONCLUSION: The proportion of Maori who have undergone heart transplantation in New Zealand compares favourably with their proportion in the New Zealand population. The reasons for the adverse diverging outcomes after five years require further investigation.
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Trasplante de Corazón/ética , Trasplante de Corazón/mortalidad , Nativos de Hawái y Otras Islas del Pacífico , Adulto , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
PURPOSE: The purpose of this study is to describe the first experience of implanting a new left ventricular assist device in pediatric patients with end-stage heart failure. DESCRIPTION: In two recent prospective, international, multicenter clinical trials, three children (aged
Asunto(s)
Insuficiencia Cardíaca/cirugía , Corazón Auxiliar , Adolescente , Cardiomiopatía Dilatada/cirugía , Niño , Terapia Combinada , Diseño de Equipo , Resultado Fatal , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/tratamiento farmacológico , Trasplante de Corazón , Humanos , Masculino , Disfunción Ventricular Izquierda/tratamiento farmacológico , Disfunción Ventricular Izquierda/etiologíaRESUMEN
We report the case of a 32-year-old heart transplant recipient who suffered several episodes of early Grade IIIA rejection and, on serial coronary angiography, demonstrated aggressive allograft vasculopathy. Severe lesions in the right coronary and left obtuse marginal arteries were stented; however, the disease was progressive and, almost 6 years after heart transplantation, she was retransplanted, providing us with the opportunity to examine the histology of transplant in-stent restenosis. She remains well 1 year after a second heart transplant operation.
Asunto(s)
Reestenosis Coronaria/prevención & control , Vasos Coronarios/patología , Rechazo de Injerto/prevención & control , Trasplante de Corazón/patología , Stents , Adulto , Angiografía Coronaria , Reestenosis Coronaria/patología , Femenino , Rechazo de Injerto/patología , Humanos , ReoperaciónRESUMEN
The diagnosis of sarcoidosis of the heart can be elusive, and is seldom established in life. We report the case of a 43-year-old man who underwent heart transplantation for presumed idiopathic dilated cardiomyopathy. Endomyocardial biopsy before transplantation showed only a mild infiltrate of lymphocytes. Histology of his explanted heart revealed extensive noncaseating granulomas and scarring, typical of sarcoidosis. A diagnosis of sarcoidosis had been made several years before by mediastinoscopic biopsy, after routine chest X-ray revealed mediastinal lymphadenopathy. Aside from the cardiac manifestations, the patient had no other symptoms of this disease. We discuss the inherent difficulties in the diagnosis of this rare but important condition, its varying presentations relating to the underlying pathology, as well as treatment options, including the role of transplantation.