RESUMO
BACKGROUND: Heart transplantation (HT) as a therapeutic option for end-stage chronic Chagas' heart disease (CCHD) is controversial. Reactivation of Trypanosoma cruzi infection and recurrence of the disease in the allograft are likely to occur. Furthermore, active myocarditis has been reported to predispose patients to an increased incidence and severity of rejection. METHODS AND RESULTS: We prospectively investigated the long-term follow-up of 10 patients with CCHD who underwent HT. Immunosuppression was based on cyclosporine A and azathioprine. T cruzi reactivation was prevented with benzonidazole. Besides allograft rejection surveillance, T cruzi infection was monitored through blood tests, myocardial biopsies, and serological tests. Over a mean follow-up period of 34 +/- 38 months (range, 73 to 124 months), 7 patients are alive and in NYHA functional class I. Life expectancy was 78% for the second year and 65% for 10 years. Rejection was less frequent in chagasic than in age- and sex-matched control patients (mean +/- SD, 1.60 +/- 1.26 versus 5.70 +/- 1.89 episodes per patient, respectively; P = .0001); decreased severity of rejection was also observed (P = .006). T cruzi parasitemias detected on three occasions were successfully treated with benzonidazole. There were no signs of recurrence of the disease in the allograft. CONCLUSIONS: These results suggest an important role of HT in the treatment of CCHD. There was a low frequency of T cruzi infection reactivation and no signs of recurrence of the disease in the allograft. The surprisingly decreased rejection incidence and severity require further studies for elucidation.
Assuntos
Cardiomiopatia Chagásica/cirurgia , Transplante de Coração , Adulto , Feminino , Seguimentos , Rejeição de Enxerto , Humanos , Infecções , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , RecidivaRESUMO
The authors report two cases of left ventricular aneurysm associated with post-infarction ventricular septal rupture. This rare association, usually aggravated by high mortality, received successful surgical treatment.
Assuntos
Aneurisma Cardíaco/etiologia , Ruptura Cardíaca Pós-Infarto/complicações , Aneurisma Cardíaco/cirurgia , Ruptura Cardíaca Pós-Infarto/cirurgia , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Ventriculografia com Radionuclídeos , Volume SistólicoAssuntos
Bioprótese/história , Próteses Valvulares Cardíacas/história , Valva Aórtica , Brasil , Dura-Máter/transplante , Próteses Valvulares Cardíacas/efeitos adversos , Próteses Valvulares Cardíacas/mortalidade , História do Século XX , Humanos , Valva Mitral , Pericárdio/transplante , Desenho de PróteseAssuntos
Procedimentos Cirúrgicos Cardíacos/história , Animais , Brasil , História do Século XX , HumanosAssuntos
Aneurisma Aórtico/cirurgia , Dissecção Aórtica/cirurgia , Adulto , Idoso , Aorta Torácica , Prótese Vascular , Doença Crônica , Ponte de Artéria Coronária , Feminino , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-OperatóriasRESUMO
Twenty-four mongrel dogs, weighing 13 to 24 kg, were used to study the effectiveness of anastomosis by Argon Laser beam. After anesthesia, intubation and controlled ventilation, they were submitted to three types of vascular anastomoses: saphenous vein intercarotid artery bypass; left mammary artery/left anterior descending coronary artery bypass; and veno-venous anastomosis. In all groups, 0.8 to 1.5 watts of Argon Laser power were applied for a total time of 90 to 300 seconds. The lower power was for veno-venous anastomoses and the greater was applied for arterial anastomoses. The mean values of resistance of the laser anastomosis to pressure-induced repture were 730 mm Hg in the immediate postoperative study, but increased to 2,500 mm Hg 30 days after surgery. No signs of occlusion were demonstrated at the anastomotic sites by the angiographic and anatomopathological studies performed.