Krystyna Malinowska

Heart transplantation in a patient with chloroquine-induced cardiomyopathy☆

We present the first report of a patient who underwent heart transplantation (HT) after endomyocardial biopsy (EMB) and revealed chloroquine-induced cardiomyopathy (CIC). This patient, who was treated with chloroquine for 6 years, developed a restrictive cardiomyopathy that progressed to congestive heart failure (CHF) resistant to medical management.

Effective oral ganciclovir prophylaxis against cytomegalovirus disease in heart transplant recipients

The presented data show the combined sequential use of i.v. G for 14 days followed by PO G for 90 days is a much more effective prophylaxis for CMVD after heart transplantation than use of i.v. G for 14 days followed by PO A for 90 days. A need for hospitalization due to CMVD is significantly reduced by this new strategy. The follow-up in group II is shorter than in group I but is now at least 6 months in group II, without any new cases in the first 6 months after cardiac transplantation. Some currently unknown adverse effect of prolonged PO G, which may be present, is not identified in this analysis.

Prevention of osteoporosis in cardiac transplant recipients

Osteoporosis is a leading cause of pretransplant and posttransplant morbidity. The need for early detection by measuring bone mineral density, even before transplant, must be emphasized. Preventive measures are not comparable. The use of calcium and vitamin D supplements, although recommended, is inadequate for the prevention of bone loss and complications such as vertebral fractures. Bisphosphonates have been shown to attenuate the bone loss and reduce fractures associated with steroid-induced osteoporosis. Small studies in transplant recipients suggest similar results. Other preventive measures such as hormone replacement therapy are also helpful. There are limited data on the administration of nasal calcitonin in transplant recipients.

Diagnostic value and safety of endomyocardial biopsy in selected patients with heart failure

Abstract Background: The routine use of endomyocardial biopsy (EMB) as a diagnostic test in the evaluation of heart failure patients (HFP) is controversial and generally unadvisable because of low diagnostic yield and potential for significant procedural morbidity and mortality. Purpose: Therefore we reviewed our experience with EMB in a large and mostly referral HFP at our tertiary care center. Methods: We retrospectively reviewed 3419 EMB records from 3/1/97 to 2/28/02 and identified 78 (2.3%) HFP, who were screened and referred for EMB by the heart failure specialists. Pre-EMB clinical diagnosis included 55% dilated cardiomyopathy, 14% prior condition (amyloid, sarcoid, lupus), 7% probable myocarditis, 11% ischemia, 6% drug toxicity, 3% hypertrophic cardiomyopathy, 3% constrictive pericarditis, 1% restrictive cardiomyopathy. EMB samples were routinely submitted for light and electron microscopy, immunofluoresence, Congo red and iron staining. Results: There were 44 (56%) men and 34 (44%) women with mean age of 50.5±18.5 (13–81) years. EMB results were non-diagnostic in 57 (73.1%) and diagnostic in 21(26.9%). Diagnostic finding consisted of 8 (10.2%) amyloid, 5 (6.4%) drug toxicity, 4 (5.1%) myocarditis, 2 (2.6%) iron overload and 2 (2.6%) immunologic/lupus. In HFP undergoing EMB there were 2 (2.6%) of right ventricular perforations as the major procedural complication. In comparison in 3341 EMB performed routinely in heart transplant recipients there were 4 (0.12%) bleedings/hematoma, 3 (0.09%) life threatening arrhythmia, 3 (0.09%) carotid puncture and 1 (0.03%) right ventricular perforation. Conclusions: In HFP without established etiology for heart failure, EMB is of diagnostic value in 26.9% of cases. Contrary to prior concerns regarding the safety of the EMB in HFP this diagnostic test can be completed with low procedural morbidity and no mortality.