A. Coverdale

Heart Transplantation in a Patient with Endomyocardial Fibrosis Due to Hypereosinophilic Syndrome

Idiopathic hypereosinophilic syndrome (HES), a systemic disease that commonly involves the heart leading to progressive endomyocardial fibrosis, frequently manifests as restrictive cardiomyopathy. In this report, we describe the first case of a patient with endomyocardial fibrosis due to HES who underwent orthotopic heart transplantation at our institution. A literature review and discussion are included.

Pulmonary venous wedge pressure: A rare indication in a heart transplant candidate

Before heart transplantation, accurate assessment of the pulmonary vascular resistance or transpulmonary gradient is required to assess perioperative risk. We describe a case where unusual steps were necessary to obtain this information. A 45-year-old man with chronic rheumatic heart disease was referred for heart transplantation. Four heart valve operations had been performed since the age of 7 years. The last operation was with Medtronic Hall aortic valve and tricuspid valves (Medtronic, Minneapolis, MI) and a Starr Edwards mitral valve (Edwards Lifesciences, Irvine, CA) replacement 12 years before his referral. A dual-chamber pacemaker was later implanted with atrial and coronary sinus leads. During a 1-year period, he had multiple hospital admissions with intractable congestive heart failure and moderate renal impairment, and was referred for heart transplant assessment. Several transthoracic echocardiograms (TTE) were performed over 8 months, with similar results. Important paravalvular mitral regurgitation was suspected, although a 3-dimensional transesophageal echocardiogram at the referring hospital did not reveal this. In other respects, the mechanical valves appeared to be functioning normally. Contractility of the left ventricle and right ventricle (RV) was moderately impaired, and both ventricles were moderately dilated (left ventricular end-systolic volume index was 51 ml/m 2 ). The TTE mean gradients across the aortic, mitral, and tricuspid valves were 11, 13, and 4 mm Hg respectively. There was no paravalvular tricuspid valve regurgitation, and RV systolic pressure could not be assessed by TTE. His jugular veins were markedly distended.

A Cross-sectional Study on Employment After Heart Transplantation in New Zealand

three and 100% of patients with a CRS of 4. Primary cardiac complications included decompensated heart failure, arrhythmia (supraventricular, second degree AV block) and severe pulmonary hypertension. Two patients underwent termination of pregnancy because of deterioration in valve function. In addition, twopatients required inpatient valve replacement in the peripartum period. Conclusion:Women with rheumatic heart disease have a higher than normal risk of complications during pregnancy and the cardiac risk index provides a useful tool in risk stratifying patients. http://dx.doi.org/10.1016/j.hlc.2013.05.607 Social Aspects of Cardiovascular Disease