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1.
Arch. cardiol. Méx ; Arch. cardiol. Méx;93(4): 417-421, Oct.-Dec. 2023. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1527718

RESUMO

Abstract Objective: The objective of this study was to describe the clinical and imaging characteristics and the evolution of heart transplantation patients due to anthracycline-induced cardiomyopathy Methods: Patients with a diagnosis of ACM who received a heart transplantation in our institution in the period of November 2009-April 2021 were included. Clinical characteristics, pre-transplant studies, and clinical outcomes after transplantation were collected retrospectively from the electronic medical record. Results: A total of 11 patients were included in the study. The median age at the time of cancer diagnosis was 15 years (IQR 10-37 years), while the median age at the time of heart transplant was 56 years (IQR 39-62 years). Regarding post-transplant outcomes, three patients died in the post-operative period. One died 4 years after the intervention due to chronic rejection, while the other seven had a favorable evolution. No oncological relapse was observed with a median follow-up of 2.5 years (IQR 1.86-3.85 years). Conclusion: End-stage anthracycline-induced cardiomyopathy can occur many years after chemotherapy treatment, so close cardiovascular follow-up is extremely important. Heart transplantation is a treatment option after an exhaustive multidisciplinary evaluation, to minimize the risk of oncological relapse.


Resumen Objetivo: Describir las características clínicas, imagenológicas y la evolución de los pacientes trasplantados cardiacos por cardiotoxicidad inducida por antraciclinas. Métodos: Serie de casos descriptiva de pacientes consecutivos trasplantados cardiacos debido a cardiotoxicidad mediada por antraciclinas en el periodo de Noviembre de 2009 a Abril de 2021.Las características clínicas, los estudios complementarios pretrasplante y la información sobre la evolución posterior al trasplante fue recolectada de la historia clínica electrónica de forma retrospectiva. Resultados: Se incluyeron un total de 11 pacientes. La mediana de edad al diagnóstico de la patología oncológica fue de 15 años (RIC 10-37 años), mientras que la mediana de edad en la que recibieron el trasplante cardiaco fue de 56 años (RIC 39-62 años). Con respecto a la evolución posterior al trasplante, 3 pacientes murieron en el periodo del post operatorio inmediato. 1 paciente falleció a los 4 años del trasplante y los otros 7 pacientes tuvieron una evolución favorable. No se observó recaída oncológica en ningún paciente durante una mediana de seguimiento o de 2,5 años (RIC 1.86-3.85 años). Conclusión: La etapa final de la miocardiopatía inducida por antraciclinas puede ocurrir muchos años después del tratamiento con quimioterapia, por lo que es extremadamente importante un seguimiento cardiológico estricto. El trasplante cardiaco es una opción en este grupo de pacientes luego de una exhaustiva evaluación multidisciplinaria, con el fin de minimizar el riesgo de recaída oncológica.

2.
Arch Cardiol Mex ; 93(4): 417-421, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37972371

RESUMO

OBJECTIVE: The objective of this study was to describe the clinical and imaging characteristics and the evolution of heart transplantation patients due to anthracycline-induced cardiomyopathy. METHODS: Patients with a diagnosis of ACM who received a heart transplantation in our institution in the period of November 2009-April 2021 were included. Clinical characteristics, pre-transplant studies, and clinical outcomes after transplantation were collected retrospectively from the electronic medical record. RESULTS: A total of 11 patients were included in the study. The median age at the time of cancer diagnosis was 15 years (IQR 10-37 years), while the median age at the time of heart transplant was 56 years (IQR 39-62 years). Regarding post-transplant outcomes, three patients died in the post-operative period. One died 4 years after the intervention due to chronic rejection, while the other seven had a favorable evolution. No oncological relapse was observed with a median follow-up of 2.5 years (IQR 1.86-3.85 years). CONCLUSION: End-stage anthracycline-induced cardiomyopathy can occur many years after chemotherapy treatment, so close cardiovascular follow-up is extremely important. Heart transplantation is a treatment option after an exhaustive multidisciplinary evaluation, to minimize the risk of oncological relapse.


OBJETIVO: Describir las características clínicas, imagenológicas y la evolución de los pacientes trasplantados cardiacos por cardiotoxicidad inducida por antraciclinas. MÉTODOS: Serie de casos descriptiva de pacientes consecutivos trasplantados cardiacos debido a cardiotoxicidad mediada por antraciclinas en el periodo de Noviembre de 2009 a Abril de 2021.Las características clínicas, los estudios complementarios pretrasplante y la información sobre la evolución posterior al trasplante fue recolectada de la historia clínica electrónica de forma retrospectiva. RESULTADOS: Se incluyeron un total de 11 pacientes. La mediana de edad al diagnóstico de la patología oncológica fue de 15 años (RIC 10-37 años), mientras que la mediana de edad en la que recibieron el trasplante cardiaco fue de 56 años (RIC 39-62 años). Con respecto a la evolución posterior al trasplante, 3 pacientes murieron en el periodo del post operatorio inmediato. 1 paciente falleció a los 4 años del trasplante y los otros 7 pacientes tuvieron una evolución favorable. No se observó recaída oncológica en ningún paciente durante una mediana de seguimiento o de 2,5 años (RIC 1.86-3.85 años). CONCLUSIÓN: La etapa final de la miocardiopatía inducida por antraciclinas puede ocurrir muchos años después del tratamiento con quimioterapia, por lo que es extremadamente importante un seguimiento cardiológico estricto. El trasplante cardiaco es una opción en este grupo de pacientes luego de una exhaustiva evaluación multidisciplinaria, con el fin de minimizar el riesgo de recaída oncológica.


Assuntos
Cardiomiopatias , Transplante de Coração , Humanos , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Antraciclinas/efeitos adversos , Estudos Retrospectivos , Cardiomiopatias/induzido quimicamente , Recidiva
3.
Eur Heart J Case Rep ; 7(10): ytad488, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37860682

RESUMO

Background: Patients with end-stage heart failure (HF) and severe pulmonary hypertension (PH) are not eligible for heart transplant due to high mortality risk. Percutaneous interventions as edge-to-edge repair of the mitral/tricuspid valves are a safe and effective therapy as a bridge for transplantation in patients who have contraindications to heart transplantations (HTs). Case summary: A 44-year-old man with a previous diagnosis of infection by human immunodeficiency virus (HIV) was admitted at the emergency room for exertional dyspnoea. He was diagnosed with a decompensated heart failure with reduced ejection fraction (HFrEF), severe mitral and tricuspid regurgitation, and high probability of PH. He presented poor response to guided medical treatment, even after implantable cardiac resynchronization therapy defibrillator (CRT-D). He was listed for a cardiac transplant, but after right catheterization, he was not an ideal candidate for transplantation, so it was decided to undergo percutaneous mitral and tricuspid edge-to-edge repair as a bridge to transplantation. The post-operative course was uneventful, with significant improvement in New York Heart Association functional class. The patient underwent a successful heart transplant 10 months after the procedure. Discussion: In patients with advanced HF due to HIV, HT is an adequate treatment option. When there are functional mitral and tricuspid regurgitation and severe PH, despite optimal treatment according to current guidelines, percutaneous mitral and tricuspid repair therapy appears to be safe and effective for control of severe PH as a bridge measure for cardiac transplantation.

4.
Gac Med Mex ; 158(2): 90-97, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35763820

RESUMO

INTRODUCTION: In Mexico, heart transplants (HTs) have been performed since 1988. OBJECTIVE: To review Mexican productivity in terms of HT between 2006 and 2019 and compare it with that of American and Iberian Peninsula countries. METHODS: Mexican information was collected from HT waiting lists (WL) and from the HTs carried out annually in the period, and was expressed as rates per million population (pmp); 2019 information was compared with that reported at the Pan American and Iberian levels. RESULTS: In the studied period, the rate of HTs in Mexico went from 0.12 pmp in 2006 to 0.25 pmp in 2019, with HTs accounting for between 1 and 2% of all solid organ transplants. Among 13 countries, in 2019 Mexico ranked 12th in the HT rate pmp and 11th in the rate of patients registered for the first time in the WL for a heart (0.42 pmp). Between 2016 and 2019, only one authorized Mexican center reached a volume higher than 10 HT/year. CONCLUSIONS: Given the low figures in the main indicators related to HT in Mexico, it is urgent to rethink health policies in heart failure and HT.


INTRODUCCIÓN: En México se realizan trasplantes de corazón (TC) desde 1988. OBJETIVO: Revisar la productividad mexicana en TC entre 2006 y 2019 y compararla con la de otros países americanos y de la península ibérica. MÉTODOS: Se recabó la información mexicana de las listas de espera (LE) de TC y de los TC realizados anualmente en el periodo, que se expresaron como tasas por millón de pobladores (pmp); la información de 2019 se comparó con la reportada en América y la península ibérica. RESULTADOS: En el periodo estudiado, los TC en México pasaron de 0.12 pmp en 2006 a 0.25 pmp en 2019 y representaron entre 1 y 2 % de todos los trasplantes de órganos sólidos. Entre 13 países, en 2019 México ocupó el 12° lugar en cuanto a la tasa de TC pmp y el 11° lugar en cuanto a la tasa del número de pacientes registrados por primera vez en la LE para un corazón (0.42 pmp). Entre 2016 y 2019, solo un centro mexicano autorizado alcanzó un volumen superior a 10 TC/año. CONCLUSIONES: Debido a las bajas cifras en los principales indicadores relacionados con el TC, en México urge replantear las políticas de salud en insuficiencia cardiaca y TC.


Assuntos
Transplante de Coração , Transplante de Órgãos , Humanos , México , Sistema de Registros , Listas de Espera
5.
Gac. méd. Méx ; Gac. méd. Méx;158(2): 93-100, mar.-abr. 2022. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1375534

RESUMO

Resumen Introducción: En México se realizan trasplantes de corazón (TC) desde 1988. Objetivo: Revisar la productividad mexicana en TC entre 2006 y 2019 y compararla con la de otros países americanos y de la península ibérica. Métodos: Se recabó la información mexicana de las listas de espera (LE) de TC y de los TC realizados anualmente en el periodo, que se expresaron como tasas por millón de pobladores (pmp); la información de 2019 se comparó con la reportada en América y la península ibérica. Resultados: En el periodo estudiado, los TC en México pasaron de 0.12 pmp en 2006 a 0.25 pmp en 2019 y representaron entre 1 y 2 % de todos los trasplantes de órganos sólidos. Entre 13 países, en 2019 México ocupó el 12° lugar en cuanto a la tasa de TC pmp y el 11° lugar en cuanto a la tasa del número de pacientes registrados por primera vez en la LE para un corazón (0.42 pmp). Entre 2016 y 2019, solo un centro mexicano autorizado alcanzó un volumen superior a 10 TC/año. Conclusiones: Debido a las bajas cifras en los principales indicadores relacionados con el TC, en México urge replantear las políticas de salud en insuficiencia cardiaca y TC.


Abstract Introduction: In Mexico, heart transplants (HTs) have been performed since 1988. Objective: To review Mexican productivity in terms of HT between 2006 and 2019 and compare it with that of American and Iberian Peninsula countries. Methods: Mexican information was collected from HT waiting lists (WL) and from the HTs carried out annually in the period, and was expressed as rates per million population (pmp); 2019 information was compared with that reported at the Pan American and Iberian levels. Results: In the studied period, the rate of HTs in Mexico went from 0.12 pmp in 2006 to 0.25 pmp in 2019, with HTs accounting for between 1 and 2% of all solid organ transplants. Among 13 countries, in 2019 Mexico ranked 12th in the HT rate pmp and 11th in the rate of patients registered for the first time in the WL for a heart (0.42 pmp). Between 2016 and 2019, only one authorized Mexican center reached a volume higher than 10 HT/year. Conclusions: Given the low figures in the main indicators related to HT in Mexico, it is urgent to rethink health policies in heart failure and HT.

7.
Insuf. card ; 15(3): 64-69, oct. 2020. ilus, tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1143099

RESUMO

Introducción. Los pacientes con insuficiencia cardíaca (IC) avanzada bajo tratamiento con inotrópicos tienden a la taquicardia sinusal, principalmente, por: 1) efecto compensador neuroendocrino, 2) efecto farmacológico, 3) imposibilidad del uso de beta bloqueantes por interferir en el efecto inotrópico. Objetivos. Evaluar mediante cateterismo pulmonar el efecto hemodinámico de la ivabradina en la taquicardia sinusal durante el tratamiento de la IC avanzada bajo contrapulsación aórtica. Material y métodos. Entre el 1° de Enero de 2014 y el 1° de Mayo de 2020, se incluyeron prospectivamente todos los pacientes admitidos al área de cardiología crítica por IC aguda de etiología isquémico-necrótica refractaria al tratamiento farmacológico vía oral e indicación de inotrópicos y contrapulsación intra-aórtica, en ritmo sinusal con más de 110 latidos por minuto (lpm) de frecuencia cardíaca. Resultados. El estudio incluyó a 55 pacientes (33 hombres) con edad promedio de 61,9 años. Post tratamiento con ivabradina, la frecuencia cardíaca bajó de 118±5 lpm a 93±8 lpm (p=0,0002), el volumen minuto cardíaco aumentó de 4637±610 ml a 5176±527 ml (p=0,03) y el volumen sistólico promedio se incrementó significativamente de 39,29±5,2 a 55,65±7,7 ml (p=0,002). No se observaron diferencias significativas pre y post tratamiento en los registros de las presiones de la aurícula derecha ni en las presiones capilar pulmonar, así como en los cálculos de resistencias vasculares sistémicas y pulmonares. No se observaron efectos adversos de las drogas hasta transcurridas cinco vidas medias luego de suspenderla. Conclusiones. La ivabradina mejora la efectividad de la contrapulsación aórtica evaluada mediante catéter de Swan Ganz en paciente con IC avanzada tratada con agentes inotrópicos.


Background. Patients with advanced heart failure (HF) under inotropic treatment tend to sinus tachycardia, mainly due to: 1) neuroendocrine compensatory effect, 2) pharmacological effect, 3) impossibility of using beta-blockers because they interfere with the inotropic effect. Objectives. To evaluate the hemodynamic effect of ivabradine on sinus tachycardia during the treatment of advanced HF under aortic balloon pump using pulmonary catheterization. Material and methods. Between January 1, 2014 and May 1, 2020, all patients admitted to the critical cardiology area for acute HF of ischemic-necrotic etiology refractory to oral pharmacological treatment and indication of inotropic drugs and aortic balloon pump were prospectively included, in sinus rhythm with more than 110 beats per minute (bpm) of heart rate. Results. The study included 55 patients (33 men) with a mean age of 61.9 years. Post-treatment with ivabradine, the heart rate decreased from 118±5 bpm to 93±8 bpm (p=0.0002), the cardiac minute volume increased from 4637±610 ml to 5176±527 ml (p=0.03) and mean stroke volume increased significantly from 39.29±5.2 to 55.65±7.7 ml (p=0.002). No significant differences were observed before and after treatment in the recordings of the pressures of the right atrium or in the pulmonary capillary pressures, as well as in the calculations of systemic and pulmonary vascular resistance. No adverse effects of the drugs were observed until five half-lives after stopping it. Conclusions. Ivabradine improves the effectiveness of aortic balloon pump evaluated by means of a Swan Ganz catheter in patients with advanced HF treated with inotropic agents.


Introdução. Pacientes com insuficiência cardíaca (IC) avançada em tratamento inotrópico tendem a apresentar taquicardia sinusal, principalmente devido a: 1) efeito compensatório neuroendócrino, 2) efeito farmacológico, 3) impossibilidade de uso de betabloqueadores por interferirem no efeito inotrópico. Objetivo. Avaliar o efeito hemodinâmico da ivabradina na taquicardia sinusal durante o tratamento da IC avançada sob contrapulsação aórtica por cateterismo pulmonar. Material e métodos. Entre 1º de Janeiro de 2014 e 1º de Maio de 2020, foram incluídos prospectivamente todos os pacientes admitidos na área de cardiologia crítica por IC aguda de etiologia isquêmico-necrótica refratária ao tratamento farmacológico oral e indicação de inotrópicos e de balão de contrapulsação intra-aórtico, em ritmo sinusal com mais de 110 batimentos por minuto (bpm) de frequência cardíaca. Resultados. O estudo incluiu 55 pacientes (33 homens) com idade média de 61,9 anos. Após o tratamento com ivabradina, a frequência cardíaca caiu de 118±5 bpm para 93±8 bpm (p=0,0002), o volume minuto cardíaco aumentou de 4637±610 ml para 5176±527 ml (p=0,03) e o volume sistólico médio aumentou significativamente de 39,29±5,2 para 55,65±7,7 ml (p=0,002). Não foram observadas diferenças significativas antes e após o tratamento nos registros das pressões do átrio direito ou nas pressões capilares pulmonares, bem como nos cálculos da resistência vascular sistêmica e pulmonar. Nenhum efeito adverso dos medicamentos foi observado até cinco meias-vidas após a descontinuação. Conclusões. A ivabradina melhora a eficácia da contrapulsação aórtica avaliada por meio de um cateter de Swan Ganz em pacientes com IC avançada tratados com agentes inotrópicos.

8.
CorSalud ; 12(2): 198-208, tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1133610

RESUMO

RESUMEN Las opciones terapéuticas son limitadas para los pacientes con insuficiencia cardíaca avanzada que se vuelven refractarios a las terapias farmacológicas convencionales. Conocer las alternativas no farmacológicas en el tratamiento de estos enfermos resulta imprescindible en su evaluación integral, y es la segunda opción terapéutica en este grupo de enfermos cada vez más prevalentes.


ABSTRACT Therapeutic options are limited for patients with advanced heart failure who become refractory to conventional drug therapies. Knowing the non-pharmacological alternatives in the management of these patients is essential in their comprehensive evaluation, and it is the second therapeutic option in this group of increasingly prevalent patients.


Assuntos
Terapêutica , Insuficiência Cardíaca
9.
Curr Heart Fail Rep ; 16(1): 7-11, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30712146

RESUMO

PURPOSE: Heart transplantation is the gold standard treatment for advanced heart failure. Left ventricular assist devices (LVADs), despite being a good option for these patients, are not quite available in developing countries. Time spent in heart transplant waiting list has increased lately even in regions where the number of transplants has also risen showing that a new strategy should be sought. RECENT FINDINGS: Transplant process organization combined with multidisciplinary work are linked to better outcomes while improvement in donor's care and in pre-transplant evaluation might be opportunities to change the long waiting list scenario. For the first time in Brazil, a survey with the most expressive heart transplant centers has been made, which allows an overview of treatment of advanced heart failure in a developing country. We also described a model of heart transplant team, which has proved to be a success when compared to the largest heart transplant centers in Latin America.


Assuntos
Insuficiência Cardíaca/cirurgia , Transplante de Coração/métodos , Avaliação de Programas e Projetos de Saúde , Listas de Espera , Brasil , Humanos
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