Opinions and fears of patients waiting for heart transplantation. (results of questionnaire)]

The purpose of the study was to assess the quality of life and opinions of heart transplant candidates about transplantation and to evaluate some psychological aspects of anticipation of the procedure. The study comprised 49 patients from the Department of Cardiac and Vascular Surgery according to a list of potential candidates from January 1991. The special questionnaire prepared by the authors was applied in the study. The main topics were: severity and treatment of heart disease, method of informing about necessity of operation and basics of transplantation, factors contributing to the ultimate decision, opinions about problems of donors and psychological aspects of disease and transplantation, especially anxiety and fear. 39 answers (34 men, 5 woman, mean age--49.6 years) were received, including 10 reports of patient's death. Respondents evaluated their compensation of illness as bad or average nearly in equal proportions, 48.3% and 51.7% respectively. They were treated in the intensive care units on average 2.6 times a year. 96.6% assessed highly the method of informing about heart transplantation, consisting of a private conversation with a physician. A similar proportion of respondents (93.1%) began to show concern about problems associated with this procedure. Up to 77.8% declared the desire of increasing their knowledge on that score emphasizing the significance of information coming from physicians. The majority of respondents were interested in postoperative management--but 40.4% stated that they did not know anything about it. 58.6% consent immediately after transplantation had been proposed by the physician.(ABSTRACT TRUNCATED AT 250 WORDS)     

Public opinion and renal transplantation: results of a sample poll

Organ transplantation is one of the most urgent and deeply felt problems in this day and age. It is a very delicate topic with its ethical, scientific, legal and political implications. Transplant surgery can be defined as a sure and irreplaceable opportunity capable of solving situations of life-threatening seriousness which could not otherwise be so effectively treated.     

Heart transplantation for end-stage valvular disease: indications and results

PURPOSE OF REVIEW: The aim of this study is to appraise the indications of a small group of heart transplanted patients with valvular disease, to analyse both their particular issues and results compared with the etiologies of other transplanted patients. RECENT FINDINGS: Analysis of recent data shows that valvular patients represent between 3 and 5% of transplantation indications. This proportion of valvular patients had a tendency to decrease in many countries. These patients on the whole have undergone multiple reoperations. Pulmonary resistance analysis has to be especially rigorous for this group. A primary excess mortality is directly related to multiple reoperations. Mean and long-term results are then strictly comparable with other etiologies. There are a few very specific indications for recurrent endocarditis in this group. SUMMARY: Valvular patients represent a subgroup of transplanted patients with a slight primary excess mortality but with identical long-term results.     

Heart failure in the elderly (from diagnosis to therapy)]

After some considerations about the importance of heart failure on the elderly, the medical literature about epidemiologic and necropsy data on etiologic forms of heart failure, is reviewed. The importance of the associated pathologies to heart failure on the elderly is evaluated in what the diagnosis and treatment of this syndrome is concerned. We characterize the physiopathologic types of heart failure on the elderly. We refer how important is to recognize the treatable forms of heart failure, mainly the aortic valve stenosis.     

Heart transplantation in a highly sensitised patient

Some patients awaiting heart transplantation may develop positive panel reactive antibodies (PRA). Several reports have demonstrated that pre-transplant sensitisation is associated with decreased survival and a higher rejection rate, and leads to the development of cardiac allograft vasculopathy. We describe our experience with a highly sensitised transplant recipient. To reduce sensitisation, three courses of immunoadsorption were administered. The PRA level decreased effectively and actual cross-match was negative. The patient underwent successful heart transplantation, and desensitisation treatment continued with immunoadsorption and intravenous immunoglobulin for five courses. Graft function remains normal at 12 months post-operatively and the clinical status of the patient is stable.     

Heart transplantation in cardiomyopathy

Within the spectrum of presently accepted candidates for heart transplantation, end-stage heart failure in dilated cardiomyopathy has become the principle indication. Although several indicators of poor prognosis have been specified, the decision for heart transplantation is primarily made on clinical grounds. Expected long-term survival after transplantation is 60 to 80% at one year and more than 50% at five years. Since July, 1983, 50 patients underwent orthotopic heart transplantation, 38 of whom had been suffering from dilated cardiomyopathy. Ages ranged from nine to 54 years with a mean of 40 years. At present, 38 patients are alive, 34 are discharged from hospital, 14 have returned to work or school. Physical capacity and cardiac function are normal. There was no difference between the cardiomyopathy patients and the coronary artery disease patients with respect to rate and severity of rejection episodes, infection and long-term findings. Heart transplantation is considered a promising routine treatment for end-stage heart failure in particular in younger patients with dilated cardiomyopathy.     

Heart transplantation in childhood

In nine patients between the ages of 3 months and 18 years with endstage heart failure, orthotopic heart transplantation was performed. Seven of these patients suffered from dilative cardiomyopathy. Additional diagnoses were tricuspid atresia in one case, and hypoplastic left-heart syndrome in another case. Seven of these children (77.7%) were catecholamine-dependent before the operation. The postoperative immunosuppressive treatment consisted of a combination therapy of cyclosporine A, azathioprine, and prednisolone, similar to the treatment in adults. Diagnosis of rejection was based on both invasive (endomyocardial biopsy) as well as noninvasive methods (intramyocardial electrogram, echocardiography, cytoimmunological monitoring). Out of nine transplanted children and adolescents, seven are presently alive and well after a mean follow-up period of 29 months. Two patients died of graft failure. One case with irreversible renal failure, secondary to chronic cyclosporine A toxicity required kidney transplantation 2 1/2 years following heart transplantation, this being the only significant late complication up to now. Our results indicate that heart transplantation allows for survival of seriously ill children and adolescents at a similar rate as that of older patient groups. Physical and social rehabilitation has been quite favorable and has been encouraging for further pursuit of this concept.     

Heart transplantation in children

Cardiac transplantation has become a standard therapeutic option for a variety of cardiac conditions in childhood in which poor cardiac output without other surgical options exists in the face of maximized medical therapy. In this review, the common diagnoses resulting in heart transplantation, risk factors and outcomes of heart transplantation in children with otherwise inoperable heart disease are discussed.     

Childhood Graves' ophthalmopathy: results of a European questionnaire study

OBJECTIVE: Evaluation of the frequency of Graves' ophthalmopathy (GO) and its management in children and adolescents up to 18 years old with Graves' hyperthyroidism. STUDY DESIGN: This was a questionnaire study (QS) among members of the European Thyroid Association and the European Society for Paediatric Endocrinology. Approximately 300 QS were sent to members with electronic addresses and 110 QS were returned from 25 countries: 52 respondents said they had no experience with Graves' disease in this age group, but 67 respondents (23 paediatric and 44 adult endocrinologists) completed the QS. RESULTS: Out of 1963 patients with juvenile Graves' hyperthyroidism seen by respondents in the last 10 years, 641 (33%) had GO; about one-third of GO cases were < or =10 years old, and two-thirds were 11-18 years old. The prevalences of GO among juvenile Graves' hyperthyroidism were 36.6, 27.3 and 25.9% in countries in which the smoking prevalence among teenagers was > or =25, 20-25 and <20% respectively (P < 0.0001 by chi(2) test). When confronted with the standard case of a 13-year-old girl with Graves' hyperthyroidism and moderately severe active GO, the diagnostic approach included on average 4.9 biochemical tests (TSH, free thyroxine (FT(4)) and TSH.R-Ab, 100-88% of respondents) and 2.4 specific investigations (thyroid ultrasound by 69%, orthopsy/visual fields/visual acuity by 64% and orbital magnetic resonance imaging or computed tomography by 63%). Antithyroid drugs were the treatment of choice for 94% of respondents; 70% recommended a wait-and-see policy and 28% corticosteroids for the co-existing GO. In variants of the standard case, a younger age did not affect therapeutic approach very much. Recurrent hyperthyroidism would still be treated with antithyroid drugs by 66%, and with (131)I by 25%. Worsening of GO or active GO when euthyroid would convince about two-thirds of respondents to initiate treatment of GO, preferably with steroids. CONCLUSION: GO occurs in 33% of patients with juvenile Graves' hyperthyroidism; its prevalence is higher in countries with a higher prevalence of smoking among teenagers. The diagnostic approach to the standard case of a 13-year-old with Graves' hyperthyroidism and moderately severe active GO involves on average five biochemical tests; thyroid as well as orbital imaging is done in 84% of cases. Antithyroid drugs remain the treatment of choice for 94% of respondents, and even so in case of recurrences (66%). For GO, 70% recommend a wait-and-see policy; intervention, preferably with steroids, is advocated by two-thirds of respondents in cases of worsening or still-active eye disease despite euthyroidism.