H. Gibbs

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.

Histology of in-stent restenosis in a transplanted heart.

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.

Heart Transplantation in Pediatric and Congenital Heart Disease A Single-Center Experience

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.

Obligatory tacrolimus formulation substitution in heart and lung transplant recipients: A national bioequivalence audit

Background: Waitemata DHB provides comprehensive cardiology inpatient services, with 35 dedicated beds, and 24/7 ward consultation at two acute hospitals. Patients admitted with congestive heart failure (CHF) are cared for by both Cardiology and General Medicine. Cardiologists select patients for admission to the cardiology beds. We investigated differences in the patients selected by Cardiology and those managed by General Medicine at North Shore Hospital. Methods:Audit of admissions in 2013 identified 46 patients with a primary diagnosis of CHF (DRGs = ‘CHF’, ‘left ventricular failure’ or ‘cardiomyopathy’) admittedunderCardiology. We randomly selected 46 out of 748 CHF patients admitted under General Medicine in 2013 as a comparison group. Results: Cardiology patients were more likely to be male (87% vs 43%), younger (<70 years = 64% vs 11%), Maori (20% vs 4%), and have severe systolic dysfunction: EF% <35% = 63% vs 36%. HFPEF was more common in General Medicine patients (3% vs 38%). Myocardial infarction (26% vs 4%) and valvular disease (26% vs 17%) were more common in Cardiology patients. Cardiology patients had far greater outpatient follow-up (72% vs 16%), and lower readmission rates (22% vs 59%). All-cause mortality at 12 months was high in the General Medicine group (15% vs 48%). Conclusion: There are significant clinical differences in patients selected for cardiologist-directed inpatient care. Further work is needed to assess whether this is the best use of specialist resources, and whether there are opportunities for improvement in the care of CHF patients remaining under the General Medicine service.

Outcome following heart transplantation in New Zealand Maori.

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.

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