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Galeone A, Bernabei A, Pesarini G, Raimondi Lucchetti M, Onorati F, Luciani GB. Ten-Year Experience with Endomyocardial Biopsy after Orthotopic Heart Transplantation: Comparison between Trans-Jugular and Trans-Femoral Approach. J Cardiovasc Dev Dis 2024; 11:115. [PMID: 38667732 PMCID: PMC11050274 DOI: 10.3390/jcdd11040115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Endomyocardial biopsy (EMB) is considered the gold standard for monitoring allograft rejection after heart transplantation. EMB is an invasive procedure that may be performed via a trans-jugular or a trans-femoral approach with a complication rate reported as less than 6%. The aim of this study was to evaluate the complication rate after EMBs in heart recipients and to compare the results of EMBs performed via a trans-jugular or a trans-femoral approach. METHODS Medical records of heart recipients undergoing EMBs between January 2012 and December 2022 were retrospectively reviewed. EMB-related complications were classified as major (death, pericardial effusion, hemopericardium, cardiac tamponade requiring a pericardiocentesis or an urgent cardiac surgery, ventricular arrythmias, permanent atrio-ventricular block requiring permanent pacing, hemothorax, pneumothorax and retroperitoneal bleeding) and minor (de novo tricuspid regurgitation, arrhythmias, coronary artery fistula, vascular access site complications). RESULTS A total of 1698 EMBs were performed during the study period at our institution in 212 heart recipients. There were 927 (55%) EMBs performed through a trans-jugular approach (TJ group) and 771 (45%) EMBs performed through a trans-femoral approach (TF group). A total of 60 (3.5%) complications were recorded, including nine (0.5%) major complications (six cardiac tamponades, two pneumothorax and one retroperitoneal bleeding) and 51 (3%) minor complications (seven coronary fistulae, five de novo tricuspid regurgitation, four supraventricular arrythmias and thirty-five vascular access site complications). No difference was found in total (38 [4%] vs. 22 [3%]; p = 0.16) and major (6 [1%} vs. 3 [0.4%]; p = 0.65) complications (32 [3%] vs. 19 [2%]; p = 0.23) between the TJ group and the TF group. No difference was found in male sex, age at time of EMB and time from HT between complicated and not complicated EMBs. CONCLUSIONS EMBs represent a safe procedure with a low risk of complications. In our experience, EMBs performed via a trans-jugular approach are as safe as the trans-femoral approach.
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Affiliation(s)
- Antonella Galeone
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy
| | - Annalisa Bernabei
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Gabriele Pesarini
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata, 37126 Verona, Italy
| | - Marcello Raimondi Lucchetti
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy
| | - Francesco Onorati
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy
| | - Giovanni Battista Luciani
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, 37126 Verona, Italy
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Zhou L, Wolfson A, Vaidya AS. Noninvasive methods to reduce cardiac complications postheart transplant. Curr Opin Organ Transplant 2022; 27:45-51. [PMID: 34907978 DOI: 10.1097/mot.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Long-term success of heart transplantation is limited by allograft rejection and cardiac allograft vasculopathy (CAV). Classic management has relied on frequent invasive testing to screen for early features of rejection and CAV to allow for early treatment. In this review, we discuss new developments in the screening and prevention of allograft rejection and CAV. RECENT FINDINGS Newer noninvasive screening techniques show excellent sensitivity and specificity for the detection of clinically significant rejection. New biomarkers and treatment targets continue to be identified and await further studies regarding their utility in preventing allograft vasculopathy. SUMMARY Noninvasive imaging and biomarker testing continue to show promise as alternatives to invasive testing for allograft rejection. Continued validation of their effectiveness may lead to new surveillance protocols with reduced frequency of invasive testing. Furthermore, these noninvasive methods will allow for more personalized strategies to reduce the complications of long-term immunosuppression whereas continuing the decline in the overall rate of allograft rejection.
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Affiliation(s)
- Leon Zhou
- Department of Cardiology, Keck School of Medicine, Los Angeles, California, USA
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3
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Seferović PM, Tsutsui H, McNamara DM, Ristić AD, Basso C, Bozkurt B, Cooper LT, Filippatos G, Ide T, Inomata T, Klingel K, Linhart A, Lyon AR, Mehra MR, Polovina M, Milinković I, Nakamura K, Anker SD, Veljić I, Ohtani T, Okumura T, Thum T, Tschöpe C, Rosano G, Coats AJS, Starling RC. Heart Failure Association of the ESC, Heart Failure Society of America and Japanese Heart Failure Society Position statement on endomyocardial biopsy. Eur J Heart Fail 2021; 23:854-871. [PMID: 34010472 DOI: 10.1002/ejhf.2190] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 12/17/2022] Open
Abstract
Endomyocardial biopsy (EMB) is an invasive procedure, globally most often used for the monitoring of heart transplant (HTx) rejection. In addition, EMB can have an important complementary role to the clinical assessment in establishing the diagnosis of diverse cardiac disorders, including myocarditis, cardiomyopathies, drug-related cardiotoxicity, amyloidosis, other infiltrative and storage disorders, and cardiac tumours. Improvements in EMB equipment and the development of new techniques for the analysis of EMB samples have significantly improved diagnostic precision of EMB. The present document is the result of the Trilateral Cooperation Project between the Heart Failure Association of the European Society of Cardiology, the Heart Failure Society of America, and the Japanese Heart Failure Society. It represents an expert consensus aiming to provide a comprehensive, up-to-date perspective on EMB, with a focus on the following main issues: (i) an overview of the practical approach to EMB, (ii) an update on indications for EMB, (iii) a revised plan for HTx rejection surveillance, (iv) the impact of multimodality imaging on EMB, and (v) the current clinical practice in the worldwide use of EMB.
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Affiliation(s)
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Dennis M McNamara
- Heart and Vascur Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arsen D Ristić
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Biykem Bozkurt
- Winters Center for Heart Failure, Cardiovascular Research Institute, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Gerasimos Filippatos
- Attikon University Hospital, Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Karin Klingel
- Cardiopathology, Institute for Pathology, University Hospital, Tuebingen, Germany
| | - Aleš Linhart
- Department of Cardiovascular Medicine, Charles University, Prague, Czech Republic
| | - Alexander R Lyon
- National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London, UK
| | - Mandeep R Mehra
- Heart and Vascular Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Marija Polovina
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Milinković
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin, Berlin, Germany
| | - Ivana Veljić
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hannover, Germany.,Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Carsten Tschöpe
- Berlin Institute of Health (BIH) and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Department of Cardiology, Campus Virchow Klinikum, Charite University, Berlin, Germany
| | - Giuseppe Rosano
- Department of Medical Sciences, IRCCS San Raffaele, Rome, Italy.,Cardiology Clinical Academic Group, St George's Hospitals NHS Trust, London, UK
| | - Andrew J S Coats
- Monash University, Melbourne, Australia.,University of Warwick, Coventry, UK
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4
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Seferović PM, Tsutsui H, Mcnamara DM, Ristić AD, Basso C, Bozkurt B, Cooper LT, Filippatos G, Ide T, Inomata T, Klingel K, Linhart A, Lyon AR, Mehra MR, Polovina M, Milinković I, Nakamura K, Anker SD, Veljić I, Ohtani T, Okumura T, Thum T, Tschöpe C, Rosano G, Coats AJS, Starling RC. Heart Failure Association, Heart Failure Society of America, and Japanese Heart Failure Society Position Statement on Endomyocardial Biopsy. J Card Fail 2021; 27:727-743. [PMID: 34022400 DOI: 10.1016/j.cardfail.2021.04.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Endomyocardial biopsy (EMB) is an invasive procedure, globally most often used for the monitoring of heart transplant rejection. In addition, EMB can have an important complementary role to the clinical assessment in establishing the diagnosis of diverse cardiac disorders, including myocarditis, cardiomyopathies, drug-related cardiotoxicity, amyloidosis, other infiltrative and storage disorders, and cardiac tumors. Improvements in EMB equipment and the development of new techniques for the analysis of EMB samples has significantly improved the diagnostic precision of EMB. The present document is the result of the Trilateral Cooperation Project between the Heart Failure Association of the European Society of Cardiology, Heart Failure Society of America, and the Japanese Heart Failure Society. It represents an expert consensus aiming to provide a comprehensive, up-to-date perspective on EMB, with a focus on the following main issues: (1) an overview of the practical approach to EMB, (2) an update on indications for EMB, (3) a revised plan for heart transplant rejection surveillance, (4) the impact of multimodality imaging on EMB, and (5) the current clinical practice in the worldwide use of EMB.
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Affiliation(s)
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Dennis M Mcnamara
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Arsen D Ristić
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Biykem Bozkurt
- Winters Center for Heart Failure, Cardiovascular Research Institute, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | - Gerasimos Filippatos
- Attikon University Hospital, Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Karin Klingel
- Cardiopathology, Institute for Pathology, University Hospital, Tuebingen, Germany
| | - Aleš Linhart
- Department of Cardiovascular Medicine, Charles University, Prague, Czech Republic
| | - Alexander R Lyon
- National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London, UK
| | - Mandeep R Mehra
- Heart and Vascular Center, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Marija Polovina
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Milinković
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - Ivana Veljić
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hannover, Germany; Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Carsten Tschöpe
- Berlin Institute of Health (BIH) and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Department of Cardiology, Campus Virchow Klinikum, Charite University, Berlin, Germany
| | - Giuseppe Rosano
- Department of Medical Sciences, IRCCS San Raffaele, Rome, Italy, and Cardiology Clinical Academic Group, St George's Hospitals NHS Trust
| | - Andrew J S Coats
- Monash University, Australia, and University of Warwick, Coventry, UK
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Bacusca AE, Tarus A, Burlacu A, Enache M, Tinica G. A Meta-Analysis on Prophylactic Donor Heart Tricuspid Annuloplasty in Orthotopic Heart Transplantation: High Hopes from a Small Intervention. Healthcare (Basel) 2021; 9:healthcare9030306. [PMID: 33801935 PMCID: PMC7998551 DOI: 10.3390/healthcare9030306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 02/26/2021] [Accepted: 03/08/2021] [Indexed: 11/18/2022] Open
Abstract
(1) Background: Tricuspid regurgitation (TR) is the most frequent valvulopathy in heart transplant recipients (HTX). We aimed to assess the influence of prophylactic donor heart tricuspid annuloplasty (TA) in orthotopic HTX (HTX-A), comparing the outcomes with those of HTX patients. (2) Methods: Electronic databases of PubMed, EMBASE, and SCOPUS were searched. The endpoints were as follows: the overall rate of postprocedural TR (immediate, one week, six months, and one year after the procedure), postoperative complications (permanent pacemaker implantation rate, bleeding), redo surgery for TR, and mortality. (3) Results: This meta-analysis included seven studies. Immediate postprocedural, one-week, six-month and one-year tricuspid insufficiency rates were significantly lower in the HTX-A group. There was no difference in permanent pacemaker implantation rate between the groups. The incidence of postoperative bleeding was similar in both arms. The rate of redo surgery for severe TR was reported only by two authors. In both publications, the total number of events was higher in the HTX cohort, meanwhile pooled effect analysis showed no difference among the intervention and control groups. Mortality at one year was similar in both arms. (4) Conclusion: Our study showed that donor heart TA reduces TR incidence in the first year after orthotopic heart transplantation without increasing the surgical complexity. This is a potentially important issue, given the demand for heart transplants and the need to optimize outcomes when this resource is scarce.
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Affiliation(s)
- Alberto Emanuel Bacusca
- Department of Cardiovascular Surgery, Cardiovascular Diseases Institute, 700503 Iasi, Romania; (A.E.B.); (A.T.); (M.E.); (G.T.)
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania
| | - Andrei Tarus
- Department of Cardiovascular Surgery, Cardiovascular Diseases Institute, 700503 Iasi, Romania; (A.E.B.); (A.T.); (M.E.); (G.T.)
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania
| | - Alexandru Burlacu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, 700503 Iasi, Romania
- Correspondence: ; Tel.: +40-7-4448-8580
| | - Mihail Enache
- Department of Cardiovascular Surgery, Cardiovascular Diseases Institute, 700503 Iasi, Romania; (A.E.B.); (A.T.); (M.E.); (G.T.)
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania
| | - Grigore Tinica
- Department of Cardiovascular Surgery, Cardiovascular Diseases Institute, 700503 Iasi, Romania; (A.E.B.); (A.T.); (M.E.); (G.T.)
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania
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6
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Anderson BA, Edwards NF. Traumatic tricuspid valve injury following pacemaker lead extraction: A case report. SONOGRAPHY 2020. [DOI: 10.1002/sono.12229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Bonita A. Anderson
- Echocardiography Laboratory The Prince Charles Hospital Brisbane Australia
| | - Natalie F. Edwards
- Echocardiography Laboratory The Prince Charles Hospital Brisbane Australia
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7
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Biatrial Versus Bicaval Orthotopic Heart Transplantation: A Systematic Review and Meta-Analysis. Ann Thorac Surg 2020; 110:684-691. [DOI: 10.1016/j.athoracsur.2019.12.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/14/2019] [Accepted: 12/17/2019] [Indexed: 11/23/2022]
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8
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Ruiz Ortiz M, Rodríguez Diego S, Delgado Ortega M, Sánchez Fernández JJ, Ortega Salas R, Carnero Montoro L, Carrasco Ávalos F, López Aguilera J, López Granados A, Arizón Del Prado JM, Romo Peñas E, Paredes Hurtado N, Oneto Fernández J, Pan M, Mesa Rubio D. Tissue Doppler velocities for ruling out rejection in heart transplant recipients in the context of myocardial strain imaging: a multivariate, prospective, single-center study. Int J Cardiovasc Imaging 2020; 36:1455-1464. [PMID: 32297099 DOI: 10.1007/s10554-020-01843-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/06/2020] [Indexed: 11/28/2022]
Abstract
To investigate the value of tissue Doppler velocities for ruling out treatment-requiring acute cellular rejection (TR-ACR), in the context of myocardial deformation analysis performed by means of speckle tracking echocardiography. We performed serial echocardiograms in 37 heart transplant recipients in their first year post-transplantation within 3 h of the routine surveillance endomyocardial biopsies (EMB). The association of the sum of lateral mitral annulus systolic (s') and early diastolic (e') velocities, in absolute values, measured by tissue Doppler echocardiography (s'+ e'), with TR-ACR (ACR grade ≥ 2R) was investigated by multivariate analysis, including classic echocardiographic parameters and myocardial deformation variables. A total of 251 pairs of EMB and echo exams were performed, 35 (14%) with rejection grade ≥ 2R (TR-ACR). s' + e' was independently associated to TR-ACR (OR 0.80, 95%CI 0.72-0.89, p < 0.0005), with a C statistic of 0.79 (95%CI 0.71-0.87, p < 0.0005) by ROC curve analysis. An s'+ e' value ≥ 23 cm/s, present in 43% of studies, had a negative predictive value of 98% for ruling out TR-ACR. Moreover, in the same patients, s'+ e' significantly decreased when TR-ACR occurred after a study without this condition (- 3.7 ± 3.3 cm/s, p = 0.003), but it was similar when rejection status was the same in the present versus the previous study. A drop in s'+ e' value < 2.7 cm/s from the previous echocardiogram, had a 99% negative predictive value for ruling out TR-ACR. Tissue Doppler velocities, a widely available echo parameter, were found to be a valuable marker for ruling out TR-ACR in this multivariate study which included myocardial deformation variables.
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Affiliation(s)
- Martín Ruiz Ortiz
- Department of Cardiology, Reina Sofia University Hospital, Cordoba, Spain.
| | | | | | | | - Rosa Ortega Salas
- Department of Pathology, Reina Sofia University Hospital, Cordoba, Spain
| | | | | | | | | | | | - Elías Romo Peñas
- Department of Cardiology, Reina Sofia University Hospital, Cordoba, Spain
| | | | | | - Manuel Pan
- Department of Cardiology, Reina Sofia University Hospital, Cordoba, Spain
| | - Dolores Mesa Rubio
- Department of Cardiology, Reina Sofia University Hospital, Cordoba, Spain
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9
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Uchihashi M, Makino M, Kaimoto S, Imai Y, Hadase M, Kurata H, Nakamura T. Platypnea-Orthodeoxia Syndrome Associated with Spontaneously Ruptured Chordae Tendineae of Tricuspid Valve. CASE 2020; 4:90-92. [PMID: 32337398 PMCID: PMC7175809 DOI: 10.1016/j.case.2019.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
POS is a rare clinical condition. Symptoms are upright posture dyspnea and arterial desaturation. Supine and sitting position oxygen saturation levels suggest right-to-left shunt. First report of uncommon spontaneous tricuspid valve chordal rupture–induced POS.
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10
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Ruiz‐Ortiz M, Rodriguez‐Diego S, Delgado M, Kim J, Weinsaft JW, Ortega R, Carnero L, Sánchez JJ, Carrasco F, López‐Aguilera J, López‐Granados A, Arizón JM, Paredes N, Oneto‐Fernandez J, Pan M, Mesa D. Myocardial deformation and acute cellular rejection after heart transplantation: Impact of inter‐vendor variability in diagnostic effectiveness. Echocardiography 2019; 36:2185-2194. [DOI: 10.1111/echo.14544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | - Mónica Delgado
- Cardiology Department Reina Sofia University Hospital Cordoba Spain
| | - Jiwon Kim
- Greenberg Division of Cardiology Weill Cornell Medical College New York NY USA
| | | | - Rosa Ortega
- Pathology Department Reina Sofia University Hospital Cordoba Spain
| | - Lucía Carnero
- Cardiology Department Reina Sofia University Hospital Cordoba Spain
| | - José J. Sánchez
- Cardiology Department Reina Sofia University Hospital Cordoba Spain
| | | | | | | | - José M. Arizón
- Cardiology Department Reina Sofia University Hospital Cordoba Spain
| | - Nick Paredes
- Cardiology Department Reina Sofia University Hospital Cordoba Spain
| | | | - Manuel Pan
- Cardiology Department Reina Sofia University Hospital Cordoba Spain
| | - Dolores Mesa
- Cardiology Department Reina Sofia University Hospital Cordoba Spain
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11
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Lower frequency routine surveillance endomyocardial biopsies after heart transplantation. PLoS One 2017; 12:e0182880. [PMID: 28841655 PMCID: PMC5571958 DOI: 10.1371/journal.pone.0182880] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/26/2017] [Indexed: 11/25/2022] Open
Abstract
In heart transplantation (HTx) patients, routine surveillance endomyocardial biopsies (rsEMB) are recommended for the detection of early cardiac allograft rejection. However, there is no consensus on the optimal frequency of rsEMB. Frequent rsEMB have shown a low diagnostic yield in the new era of potent immunosuppressive regimen. Efficacy and safety of lower frequency rsEMB have not been investigated so far. In this retrospective, single centre, observational study we evaluated 282 patients transplanted between 2004 and 2014. 218 of these patients were investigated by rsEMB and symptom-triggered EMB (stEMB). We evaluated EMB results, complications, risk factors for rejection, survival 1 and 5 years as well as incidence of cardiac allograft vasculopathy (CAV) 3 years after HTx. A mean of 7.1 ± 2.5 rsEMB were conducted per patient within the first year after HTx identifying 7 patients with asymptomatic and 9 patients with symptomatic acute rejection requiring glucocorticoide pulse therapy. Despite this relatively low frequency of rsEMB, only 6 unscheduled stEMB were required in the first year after HTx leading to 2 additional treatments. In 6 deaths among all 282 patients (2.1%), acute rejection could not be ruled out as a potential underlying cause. Overall survival at 1 year was 78.7% and 5-year survival was 74%. Incidence of CAV was 17% at 3-year follow-up. Morbidity and mortality of lower frequency rsEMB are comparable with data from the International Society for Heart and Lung Transplantation (ISHLT) registry. Consensus is needed on the optimal frequency of EMB.
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12
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Greenway SC, Dallaire F, Kantor PF, Dipchand AI, Chaturvedi RR, Warade M, Riesenkampff E, Yoo SJ, Grosse-Wortmann L. Magnetic resonance imaging of the transplanted pediatric heart as a potential predictor of rejection. World J Transplant 2016; 6:751-758. [PMID: 28058227 PMCID: PMC5175235 DOI: 10.5500/wjt.v6.i4.751] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/04/2016] [Accepted: 11/27/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate cardiac magnetic resonance imaging (CMR) as a non-invasive tool to detect acute cellular rejection (ACR) in children after heart transplant (HT). METHODS Thirty pediatric HT recipients underwent CMR at the time of surveillance endomyocardial biopsy (EMB) and results were compared to 14 non-transplant controls. Biventricular volumes, ejection fractions (EFs), T2-weighted signal intensities, native T1 times, extracellular volumes (ECVs) and presence of late gadolinium enhancement (LGE) were compared between patients and controls and between patients with International Society of Heart and Lung Transplantation (ISHLT) grade ≥ 2R rejection and those with grade 0/1R. Heart rate (HR) and brain natriuretic peptide (BNP) were assessed as potential biomarkers. RESULTS Significant ACR (ISHLT grade ≥ 2R) was an infrequent event in our population (5/30, 17%). Ventricular volumes, EFs, LGE prevalence, ECVs, native T1 times, T2 signal intensity ratios, HR and BNP were not associated with the presence of ≥ 2R ACR. CONCLUSION In this pilot study CMR did not reliably identify ACR-related changes in pediatric HT patients.
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Urbanowicz T, Michalak M, Kociemba A, Straburzyńska-Migaj E, Katarzyński S, Grajek S, Jemielity M. Predictors of Tricuspid Valve Anulus Dilation in a Heart Recipient Population. Transplant Proc 2016; 48:1742-5. [PMID: 27496483 DOI: 10.1016/j.transproceed.2016.01.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 01/21/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Tricuspid valve regurgitation in reported in >20% of heart recipients. It severity has not only clinical impact, but it is also associated with increased mortality. Risk factors for developing tricuspid valve dysfunction include allograft rejection, donor/recipient pericardial cavity mismatch, preoperative transpulmonary gradient and vascular resistance, biatrial anastomosis technique, and biopsy-induced injury. Tricuspid valve annulus distention is reported to causative factor for most common type of tricuspid valve dysfunction after heart transplantation. The aim of the study was to estimate possible early predictors for tricuspid valve regurgitation after orthotopic heart transplantation performed with standard Lower-Shumway technique on magnetic resonance imaging studies. METHODS A total of 20 patients (18 men and 2 women) with a mean age of 45 ± 12 years were enrolled into the study. Echocardiographic evaluation followed by magnetic resonance studies were performed. The mean duration from time of transplantation was 34 ± 12 months. Magnetic resonance and echocardiographic imaging focused on tricuspid valve annulus diameter and atrium dimensions. RESULTS The was a progressive distension of tricuspid valve annulus observed during the follow-up period. Mean tricuspid valve diameter increased from 3.0 ± 0.3 to 3.34 ± 0.3 mm (P < .05). There was a positive correlation observed between recipient native right atrium and overall right atrium diameter and tricuspid valve diameter distension. CONCLUSIONS Overall right atrium diameter and native recipient right atrium diameter were found to be a risk factor for tricuspid valve annulus distension.
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Affiliation(s)
- T Urbanowicz
- Cardiac Surgery and Transplantology Department, Chair of Cardio-Thoracic Surgery, Poznań University of Medical Sciences, Poznań, Poland.
| | - M Michalak
- Biostatistics Department, Poznań University of Medical Sciences, Poznań, Poland
| | - A Kociemba
- Cardiology Department, Poznań University of Medical Sciences, Poznań, Poland
| | | | - S Katarzyński
- Cardiac Surgery and Transplantology Department, Chair of Cardio-Thoracic Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | - S Grajek
- Cardiology Department, Poznań University of Medical Sciences, Poznań, Poland
| | - M Jemielity
- Cardiac Surgery and Transplantology Department, Chair of Cardio-Thoracic Surgery, Poznań University of Medical Sciences, Poznań, Poland
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14
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Accidental Entrapment of Electrical Mapping Catheter by Chiari's Network in Right Atrium during Catheter Ablation Procedure. Case Rep Cardiol 2016; 2016:1302473. [PMID: 27366332 PMCID: PMC4912992 DOI: 10.1155/2016/1302473] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/12/2016] [Indexed: 11/17/2022] Open
Abstract
A 78-year-old male was admitted to our hospital due to frequent palpitation. His electrocardiogram (ECG) presented regular narrow QRS tachycardia with 170 bpm, and catheter ablation was planned. During electroanatomical mapping of the right atrium (RA) with a multiloop mapping catheter, the catheter head was entrapped nearby the ostium of inferior vena cava. Rotation and traction of the catheter failed to detach the catheter head from the RA wall. Exfoliation of connective tissue twined around catheter tip by forceps, which were designed for endomyocardial biopsy, succeeded to retract and remove the catheter. Postprocedural echocardiography and pathologic examination proved the existence of Chiari's network. The handling of complex catheters in the RA has a potential risk of entrapment with Chiari's network.
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15
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Toscano G, Gambino A, Bagozzi L, Guariento A, D'Amico G, Fedrigo M, Gerosa G. Endomyocardial biopsy under echocardiographic monitoring. Multimed Man Cardiothorac Surg 2016; 2016:mmw006. [PMID: 27247327 DOI: 10.1093/mmcts/mmw006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 02/19/2016] [Indexed: 06/05/2023]
Abstract
Endomyocardial biopsy is a common procedure for monitoring cardiac allograft rejection; several techniques have been described so far, throughout different access sites and under echocardiographic or X-ray control. We describe the routine technique adopted at our centre based on echo-guided puncture of jugular vein and echocardiographic assessment of endomyocardial sampling with direct visualization of the bioptome tip. We also report the most common complications of the procedure, especially concerning the risk of iatrogenic tricuspid regurgitation, and same examples of histopathological findings drawn from our own iconographic collection.
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Affiliation(s)
- Giuseppe Toscano
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Antonio Gambino
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Lorenzo Bagozzi
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Alvise Guariento
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Gianpiero D'Amico
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Marny Fedrigo
- Division of Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
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16
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Oliemy A, Mahesh B, Pathi V. Acute Traumatic Right to Left Cardiac Shunt. Ann Thorac Surg 2016; 102:e303-4. [PMID: 26926097 DOI: 10.1016/j.athoracsur.2016.02.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 02/17/2016] [Accepted: 02/22/2016] [Indexed: 11/16/2022]
Abstract
Cardiac injuries after penetrating chest trauma are uncommon but potentially life threatening; these injuries can remain occult during the early stage because of the cardiac reserve of youthful physiology and may present at a later stage as the initial damage progresses or compensatory mechanisms fail. We report a case of unusual penetrating cardiac trauma from a posterior intercostal stab wound that affected both the interatrial septum and the tricuspid valve, leading to a stormy presentation as a result of the development of an acute right-to-left shunt followed by a successful surgical repair.
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Affiliation(s)
- Ahmed Oliemy
- Cardiac Surgery and Transplant Department, Golden Jubilee National Hospital, Glasgow, United Kingdom.
| | - Balakrishnan Mahesh
- Cardiac Surgery and Transplant Department, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Vivek Pathi
- Cardiac Surgery and Transplant Department, Golden Jubilee National Hospital, Glasgow, United Kingdom
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Godown J, Harris MT, Burger J, Dodd DA. Variation in the use of surveillance endomyocardial biopsy among pediatric heart transplant centers over time. Pediatr Transplant 2015; 19:612-7. [PMID: 25943967 DOI: 10.1111/petr.12518] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 11/28/2022]
Abstract
EMB is widely utilized for graft surveillance after HTx; however, there is significant variation in the frequency of surveillance EMB use during the first year post-HTx. The aim of this study was to assess changes in the utilization of surveillance EMB over time among member institutions of PHTS. A survey of PHTS centers assessing the frequency of surveillance EMB use during the first year post-HTx was conducted in 2006. The same survey was repeated in 2014 to assess changes in practice over time. The number of EMB in infants ranged from 0 to 9 and in adolescents 0 to 16. The number of EMB decreased or remained unchanged in the majority of centers. Fewer EMB are performed in infants compared to adolescents and this practice did not change over time. There was a significant decrease in surveillance EMB use in adolescents (p = 0.012). International centers perform significantly fewer EMB in adolescents when compared to centers within the United States (p = 0.006). There continues to be significant variation in the utilization of surveillance EMB, with a shift toward less reliance on EMB for adolescents in the current era. Further research is necessary to determine the optimal frequency of invasive monitoring that reduces costs without compromising outcomes.
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Affiliation(s)
- Justin Godown
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Michelle T Harris
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Judith Burger
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Debra A Dodd
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
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