1
|
Radovanovic D, Muggli F, Bianchetti M, Gallino A, Parati G, Suter PM, Schoenenberger-Berzins R, Erne P, Schoenenberger AW. Comparison of office, home and ambulatory blood pressure measurements in hypertensive and suspected hypertensive SWICOS participants. Blood Press 2023; 32:2234496. [PMID: 37452435 DOI: 10.1080/08037051.2023.2234496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Hypertension should be confirmed with the use of home BP measurement (HBPM) or 24h ambulatory BP measurement (ABPM). The aim of our study was to compare measurements obtained by OBPM, HBPM and ABPM in individuals with elevated OBPM participating in the population-based Swiss Longitudinal Cohort Study (SWICOS). MATERIAL AND METHODS Participants with OBPM ≥140/90 mmHg assessed their BP using HBPM and ABPM. The cut-off for hypertension was ≥135/85 mmHg for HBPM, ≥130/80 mmHg for ABPM. White-coat hypertension (WCH) was defined as normal HPBM and ABPM in participants not taking antihypertensive drugs. Uncontrolled hypertension was defined as hypertension in HBPM or ABPM despite antihypertensive treatment. RESULTS Of 72 hypertensive subjects with office BP ≥140/90 mmHg and valid measurements of HBPM and ABPM, 39 were males (aged 62.8 ± 11.8y), 33 were females (aged 57.4 ± 14.2y). Hypertension was confirmed with HBPM and ABPM in 17 participants (24%), with ABPM only in 24 further participants (33%), and with HBPM only in 2 further participants (3%). Participants who had hypertension according to ABPM but not HBPM were younger (59 ± 11 y versus 67 ± 16 y; p < 0.001) and more frequently still working (83% versus 23%; p < 0.001). The prevalence of WCH was 28%. Among the 32 subjects taking antihypertensive drugs, uncontrolled hypertension was found in 49%. CONCLUSION This population-based study found a high prevalence of WCH and potential uncontrolled hypertension among individuals with elevated OBPM. This study, therefore, supports the ESH recommendations of complementing OBPM by ABPM or HBPM. The use of HBPM instead of ABPM for the confirmation of hypertension in individuals with elevated OBPM might lead to underdiagnosis and uncontrolled hypertension, in particular in the younger working population. In these individuals, this study suggests using ABPM instead of HBPM.
Collapse
Affiliation(s)
- D Radovanovic
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - F Muggli
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - M Bianchetti
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - A Gallino
- Cardiovascular Research Unit, Dep. Medicina Interna, San Giovanni Hospital, Bellinzona, Switzerland
| | - G Parati
- Istituto Auxologico Italiano, IRCCS, Cardiology Unit and Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - P M Suter
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | | | - P Erne
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - A W Schoenenberger
- Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Medizinische Klinik, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| |
Collapse
|
2
|
Nanchen D, Von Kanel T, Ehret G, Brun N, Sudano I, Rodondi N, Rickli H, Girod G, Ballhausen D, Falciano R, Beer JH, Gallino A. Comparison of severe hypercholesterolemia patients with and without pathogenic variants. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
A pathogenic variant causally related to familial hypercholesterolemia (FH) is found in less than half of adults with severe hypercholesterolemia. The characteristics of adults with severe hypercholesterolemia without pathogenic variant have been poorly described, and it remains unclear whether intensive preventive strategies should be recommended. In this study we compared the characteristics of adults with severe hypercholesterolemia with and without pathogenic variant for FH.
Methods
Between November 2020 and February 2022, we recruited individuals older than 16 years with a Dutch Lipid Clinic Network (DLCN) score ≥6 and genotyped LDLR, APOB and PCSK9. Participants were part of the multicenter CATCH study, testing the implementation of genetic cascade screening for FH in Switzerland. All genetic analyses were performed in a single central laboratory. Variants classified as likely pathogenic or pathogenic were interpreted as FH-causing. We also assessed socio-economic status, cardiovascular risk factors, lifestyle behavior, and use of lipid-lowering drugs.
Results
In total, 150 non-related adults with a DLCN score of ≥6 were included, out of whom 62 (41.3%) had genetically confirmed FH. Most variants were found in the LDLR gene (77%). Overall, 70% were using a lipid-lowering drug and 20% were current smokers. Compared to adults with genetically confirmed FH, those without pathogenic variants were older (57.6 vs 50.4 years old), had lower untreated LDL-cholesterol levels (p<0.001), higher triglyceride levels (p=0.032), higher BMI (p=0.014), and had more frequently hypertension (62.5% vs 36.1%). No socio-economic differences were observed. Although adherence to Mediterranean diet was higher among adults without pathogenic variant, they reached less frequently the recommended level of physical activity than adults with genetically confirmed FH (66.2% vs 82.1%). Xanthomas or xanthelasmas, but not corneal arcus, were more frequent among genetically confirmed FH (5.7% vs 20.3%).
Conclusions
Adults with severe hypercholesterolemia and without a pathogenic FH variant had less optimal control of cardiovascular risk factors than genetically confirmed FH. One fifth were smokers and one third of all patients included in this study were not taking any lipid-lowering drugs, regardless of the presence of a pathogenic variant.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Swiss Heart Foundation
Collapse
Affiliation(s)
- D Nanchen
- University of Lausanne , Lausanne , Switzerland
| | - T Von Kanel
- Hospital Center of Valais , Sion , Switzerland
| | - G Ehret
- Geneva University Hospitals , Geneva , Switzerland
| | - N Brun
- Geneva University Hospitals , Geneva , Switzerland
| | - I Sudano
- University Hospital Zurich , Zurich , Switzerland
| | - N Rodondi
- Inselspital - University of Bern , Bern , Switzerland
| | - H Rickli
- Kantonsspital St. Gallen , St Gallen , Switzerland
| | - G Girod
- Hospital Center of Valais , Sion , Switzerland
| | - D Ballhausen
- University Hospital Centre Vaudois (CHUV) , Lausanne , Switzerland
| | - R Falciano
- Hospital of San Giovanni , Bellinzona , Switzerland
| | - J H Beer
- Cantonal Hospital of Baden , Baden , Switzerland
| | - A Gallino
- Hospital of San Giovanni , Bellinzona , Switzerland
| |
Collapse
|
3
|
Nanchen D, Von Känel T, Brun N, Sudano I, Rickli H, Ehret G, Girod G, Del Giorno R, Rodondi N, Beer J, Gallino A. Implementation of cascade genetic screening for familial hypercholesterolemia: Design of the Swiss catch randomized controlled trial. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
4
|
Cattaneo MM, Pravatà E, Provenzi M, Moccetti M, Kaelin A, Sudano I, Crea F, Biasucci L, Limoni C, Calanchini C, Cattaneo M, Gallino A. The Role of the Central Autonomic Nervous System and Psychosocial Factors in Microvascular Angina and Takotsubo Syndrome. Eur Cardiol 2020; 15:e38. [PMID: 32612698 PMCID: PMC7312794 DOI: 10.15420/ecr.2020.15.1.po15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - M Cattaneo
- Bellinzona, Switzerland.,Lugano, Switzerland
| | - A Gallino
- Bellinzona, Switzerland.,Zurich, Switzerland
| |
Collapse
|
5
|
Helck A, Bianda N, Ganton G, Yuan C, Reiser M, Gallino A, Wyttenbach R, Saam T. Intra-individueller Vergleich der Plaquemorphologie in den Karotiden und Femoralarterien mithilfe der nicht-invasiven MRT-Plaquebildgebung. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1372903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
6
|
Catalano M, Poredos P, Brodmann M, Wautrecht JC, Carpentier P, Roztocil K, Nikol S, Diamantopoulos E, Pecsvarady Z, Carlizza A, Sieron A, Stanek A, Olinic D, Stvrtinova V, Kozak M, Agewall S, Gallino A, Jaeger KA, Fitzgerald P, Colgan MP. Requirements for angiology/vascular medicine. INT ANGIOL 2013; 32:608-612. [PMID: 24212296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- M Catalano
- UEMS Division of Angiology Vascular Medicine -
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Di Valentino M, Siragusa P, Moschowitis G, Gallino JM, Costanzo L, Gallino A, Menafoglio A. The characteristics of infero-lateral early repolarisation are different between young males and females athletes. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.1904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
8
|
Porretta AP, Di Valentino M, Muzzarelli S, Limoni C, Pedrazzini G, Kaiser C, Moccetti T, Osswald S, Gallino A. Long-term implications on the incidence of ST-Elevation Myocardial Infarction after implementation of a public smoking ban: a comparison between cantons in Switzerland. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
9
|
Bianda N, Di Valentino M, Periat D, Segatto JM, Oberson M, Moccetti M, Sudano I, Santini P, Limoni C, Froio A, Stuber M, Corti R, Gallino A, Wyttenbach R. Progression of human carotid and femoral atherosclerosis: a prospective follow-up study by magnetic resonance vessel wall imaging. Eur Heart J 2011; 33:230-7. [DOI: 10.1093/eurheartj/ehr332] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
|
10
|
Györik S, Ceriani L, Menafoglio A, Gallino A, Wyttenbach R. F-FDG PET scan as follow-up tool for sarcoidosis with symptomatic cardiac conduction disturbances requiring a pacemaker. BMJ Case Rep 2009; 2009:bcr2006070805. [PMID: 21687094 DOI: 10.1136/bcr.2006.070805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- S Györik
- Division of Pneumology, Ospedale San Giovanni, Bellinzona, Switzerland
| | | | | | | | | |
Collapse
|
11
|
Wyttenbach R, Corti R, Alerci M, Cozzi L, Di Valentino M, Segatto J, Badimon J, Fuster V, Gallino A. Effects of Percutaneous Transluminal Angioplasty and Endovascular Brachytherapy on Vascular Remodeling of Human Femoropopliteal Artery: 2 Years Follow-up by Noninvasive Magnetic Resonance Imaging. J Vasc Surg 2007. [DOI: 10.1016/j.jvs.2007.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
12
|
Wyttenbach R, Corti R, Alerci M, Cozzi L, Di Valentino M, Segatto JM, Badimon JJ, Fuster V, Gallino A. Effects of percutaneous transluminal angioplasty and endovascular brachytherapy on vascular remodeling of human femoropopliteal artery: 2 years follow-up by noninvasive magnetic resonance imaging. Eur J Vasc Endovasc Surg 2007; 34:416-23. [PMID: 17689112 DOI: 10.1016/j.ejvs.2007.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Accepted: 05/19/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We aimed to assess in vivo the long-term effects of percutaneous transluminal angioplasty (PTA) and endovascular brachytherapy (EVBT) on vessel wall by serial MRI. METHODS Twenty patients with symptomatic stenosis of the femoropopliteal artery were randomly assigned to PTA (n=10) or PTA+EVBT (n=10, 14Gy by gamma-source). High-resolution MRI was performed prior, at 24-hours, 3-months, and 24-months after intervention. MRI data were analyzed by an independent, blinded observer. RESULTS The effects of both procedures on vessel wall at 24-hours and 3-months have been reported. Despite similar percent decrease in lumen area between 3- and 24-months in both groups (-8% for PTA and -11% for PTA+EVBT), at 24-months lumen area gain compared to baseline was +30% in PTA versus +82% in PTA+EVBT (p<0.05). Total vessel area, which was increased at 24-hours and 3-months, returned to pre-treatment value in both groups. CONCLUSIONS We demonstrated non-invasively that restenosis and inward remodeling after PTA are delayed by EVBT. At 24-months, patients treated with brachytherapy have larger lumen than those treated with PTA alone. The decrease in luminal and total vessel area between 3- and 24-months after EVBT indicates that the restenotic and remodeling process is not abolished but delayed with this therapy.
Collapse
Affiliation(s)
- R Wyttenbach
- Department of Radiology, Ospedale San Giovanni Bellinzona, Switzerland
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Györik S, Ceriani L, Menafoglio A, Gallino A, Wyttenbach R. 18F-FDG PET scan as follow-up tool for sarcoidosis with symptomatic cardiac conduction disturbances requiring a pacemaker. Thorax 2007; 62:560. [PMID: 17536038 PMCID: PMC2117222 DOI: 10.1136/thx.2006.070805] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- S Györik
- Division of Pneumology, Ospedale San Giovanni, Bellinzona, Switzerland.
| | | | | | | | | |
Collapse
|
14
|
de Braud F, Sessa C, Gallerani E, Curigliano G, Cipolla C, Columbo A, Gallino A, Schackleton G, Zilocchi C, Chadjaa M. Phase I dose escalation study of SR271425 administered as 24-hour intravenous continuous infusion in patients with refractory solid tumors. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- F. de Braud
- Inst Europeo di Oncologia, Milano, Italy; Oncologia Institute of Southern Bellinzona, Bellinzona, Switzerland; Sanofi-Aventis, Alnwick, United Kingdom; Sanofi-Aventis, Chilly-Mazarin, France
| | - C. Sessa
- Inst Europeo di Oncologia, Milano, Italy; Oncologia Institute of Southern Bellinzona, Bellinzona, Switzerland; Sanofi-Aventis, Alnwick, United Kingdom; Sanofi-Aventis, Chilly-Mazarin, France
| | - E. Gallerani
- Inst Europeo di Oncologia, Milano, Italy; Oncologia Institute of Southern Bellinzona, Bellinzona, Switzerland; Sanofi-Aventis, Alnwick, United Kingdom; Sanofi-Aventis, Chilly-Mazarin, France
| | - G. Curigliano
- Inst Europeo di Oncologia, Milano, Italy; Oncologia Institute of Southern Bellinzona, Bellinzona, Switzerland; Sanofi-Aventis, Alnwick, United Kingdom; Sanofi-Aventis, Chilly-Mazarin, France
| | - C. Cipolla
- Inst Europeo di Oncologia, Milano, Italy; Oncologia Institute of Southern Bellinzona, Bellinzona, Switzerland; Sanofi-Aventis, Alnwick, United Kingdom; Sanofi-Aventis, Chilly-Mazarin, France
| | - A. Columbo
- Inst Europeo di Oncologia, Milano, Italy; Oncologia Institute of Southern Bellinzona, Bellinzona, Switzerland; Sanofi-Aventis, Alnwick, United Kingdom; Sanofi-Aventis, Chilly-Mazarin, France
| | - A. Gallino
- Inst Europeo di Oncologia, Milano, Italy; Oncologia Institute of Southern Bellinzona, Bellinzona, Switzerland; Sanofi-Aventis, Alnwick, United Kingdom; Sanofi-Aventis, Chilly-Mazarin, France
| | - G. Schackleton
- Inst Europeo di Oncologia, Milano, Italy; Oncologia Institute of Southern Bellinzona, Bellinzona, Switzerland; Sanofi-Aventis, Alnwick, United Kingdom; Sanofi-Aventis, Chilly-Mazarin, France
| | - C. Zilocchi
- Inst Europeo di Oncologia, Milano, Italy; Oncologia Institute of Southern Bellinzona, Bellinzona, Switzerland; Sanofi-Aventis, Alnwick, United Kingdom; Sanofi-Aventis, Chilly-Mazarin, France
| | - M. Chadjaa
- Inst Europeo di Oncologia, Milano, Italy; Oncologia Institute of Southern Bellinzona, Bellinzona, Switzerland; Sanofi-Aventis, Alnwick, United Kingdom; Sanofi-Aventis, Chilly-Mazarin, France
| |
Collapse
|
15
|
Chopard P, Dörffler-Melly J, Hess U, Wuillemin WA, Hayoz D, Gallino A, Bachli EB, Canova CR, Isenegger J, Rubino R, Bounameaux H. Venous thromboembolism prophylaxis in acutely ill medical patients: definite need for improvement. J Intern Med 2005; 257:352-7. [PMID: 15788005 DOI: 10.1111/j.1365-2796.2005.01455.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM OF THE STUDY To examine the frequency and adequacy of thromboprophylaxis in acutely ill medical patients hospitalized in eight Swiss medical hospitals. METHODS A cross-sectional study of 1372 patients from eight Swiss hospitals was carried out. After exclusion of patients (275) given therapeutic anticoagulation, 1097 patients were audited. The adequacy of thromboprophylaxis was assessed by comparison with predefined explicit criteria. RESULTS Of 1097 patients, 542 (49.4%) received thromboprophylaxis. According to the explicit criteria, 644 (58.7%) should have been on prophylaxis (P < 0.001, when compared with the rate observed). The rate of prevention differed widely between hospitals (from 29.4 to 88.6%) with no difference between teaching and nonteaching hospitals. According to the explicit criteria, a substantial proportion (44.9%) of the patients who should have been treated were not. Conversely, 41.3% of the patients were unnecessarily treated. CONCLUSIONS Even though the appropriateness of the explicit criteria used could be challenged, our data suggest that the current practice is associated with important uncertainty leading to both overuse and underuse of thromboprophylaxis in patients hospitalized in medical wards. More efforts are urgently needed to develop new or endorse existing explicit, evidence-based criteria and guidelines for thromboprophylaxis in this population of patients.
Collapse
Affiliation(s)
- P Chopard
- Faculty of Medicine, University Hospitals, Geneva, Switzerland.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Bonvini RF, Alerci M, Antonucci F, Vandoni RE, Braghetti A, Gertsch P, Bogen M, Gallino A. Extrahepatic arterioportal fistula: three-dimensional reconstruction of computerized tomodensitometric scan for diagnosis and morphologic assessment. Abdom Imaging 2004; 29:463-6. [PMID: 15024512 DOI: 10.1007/s00261-003-0148-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Arterioportal fistulae (APFs) are rare. An asymptomatic APF was suspected by computed tomography. Multiplanar, maximum intensity projection, and surface shaded display reconstructions showed its anatomy. To our knowledge, this is the first report using such reconstructions to analyze the architecture of an extrahepatic APF. Complete assessment of APF can be achieved noninvasively, and initial endovascular treatment can be planned.
Collapse
Affiliation(s)
- R F Bonvini
- Department of Vascular Medicine, Ospedale Regionale Bellinzona e Valli, 6500 Bellinzona, Switzerland
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Vassalli G, Gallino A, Weis M, von Scheidt W, Kappenberger L, von Segesser LK, Goy JJ. Alloimmunity and nonimmunologic risk factors in cardiac allograft vasculopathy. Eur Heart J 2003; 24:1180-8. [PMID: 12831811 DOI: 10.1016/s0195-668x(03)00237-9] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Graft vasculopathy is an accelerated form of coronary artery disease that occurs in transplanted hearts. Despite major advances in immunosuppression, the prevalence of the disease has remained substantially unchanged during the last two decades. According to the 'response to injury' paradigm, graft vasculopathy is the result of a continuous inflammatory response to tissue injury initiated by both alloantigen-dependent and independent stress responses. Experimental evidence suggests that these responses may become self-sustaining, as allograft re-transplantation into the donor strain at a later stage fails to prevent disease progression. Histological evidence of endothelitis and arteritis, in association with intima fibrosis and atherosclerosis, reflects the central role of alloimmunity and inflammation in the development of arterial lesions. Experimental results in gene-targeted mouse models indicate that cellular and humoral immune responses are both involved in the pathogenesis of graft vasculopathy. Circulating antibodies against donor endothelium are found in a significant number of patients, but their pathogenic role is still controversial. Alloantigen-independent factors include donor-transmitted coronary artery disease, surgical trauma, ischaemia-reperfusion injury, viral infections, hyperlipidaemia, hypertension, and glucose intolerance. Recent therapeutic advances include the use of novel immunosuppressive agents such as sirolimus (rapamycin), HMG-CoA reductase inhibitors, calcium channel blockers, and angiotensin converting enzyme inhibitors. Optimal treatment of cardiovascular risk factors remains of paramount importance.
Collapse
Affiliation(s)
- G Vassalli
- Division of Cardiology, University Hospital, Lausanne, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
18
|
Bonvini R, Wyttenbach R, Ghisla R, Gargiulo G, Gallino A. Images in cardiovascular medicine. Type a aortic dissection in a patient with congenital coarctation of the aorta: emergency surgical repair with an extra-anatomic bypass. Circulation 2002; 106:e74-5. [PMID: 12379589 DOI: 10.1161/01.cir.0000035279.96669.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- R Bonvini
- Division of Cardiovascular Medicine, Ospedale San Giovanni, Bellinzona, Switzerland
| | | | | | | | | |
Collapse
|
19
|
Abstract
BACKGROUND Cardiac surgery is generally well or over-represented in many Western countries. Since the southern part of Switzerland relies on 300 km distance centers for cardiac surgery, we started a project of telemedicine for the distant evaluation of cardiac surgery candidates. We report our experience of the results of the diagnosis made by telemedicine and by direct scrutiny of coronary angiograms. METHODS Coronary angiography was performed at the distant hospital by an invasive cardiology team. Teletransmission of images was performed using three Integrated Service Digital Network (ISDN) lines by direct transmission of recent recording. A total of 98 cases were reviewed (87 aorto-coronary bypass candidates, seven valvular and four congenital heart disease). We further performed a prospective blinded comparison of 47 consecutive cases with severe coronary artery disease (CAD) with respect to localization and number of significant coronary lesions, obtained by direct scrutiny of the original angiograms and the evaluation obtained with the teletransmitted images. RESULTS In 89 cases of the 98 analyzed (91%) correct diagnosis and surgical approach could be established by distant transmission. In nine cases (9%, all aortocoronary bypass candidates) definitive diagnosis and treatment was feasible only by direct scrutiny of the original angiograms. Five critically ill patients were urgently referred to the surgical care center based on the correct distant diagnosis. The blinded comparison of distant diagnosis and direct scrutiny of angiograms in defining 1-2-3 vessel CAD was good: r=0.87, P<0.01. CONCLUSION Initial experience using non-sophisticated telemedical transmission of angiograms of cardiac surgery candidates seems to be a promising facility for distantly located centers.
Collapse
Affiliation(s)
- R F Bonvini
- Division of Cardiology, Ospedale San Giovanni, CH-6500 Bellinzona, Switzerland
| | | | | | | | | | | |
Collapse
|
20
|
von Segesser LK, Marty B, Ruchat P, Bogen M, Gallino A. Routine use of intravascular ultrasound for endovascular aneurysm repair: angiography is not necessary. Eur J Vasc Endovasc Surg 2002; 23:537-42. [PMID: 12093071 DOI: 10.1053/ejvs.2002.1657] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION to assess the outcome of endovascular aortic aneurysm repair (EVAR) using intravascular ultrasound (IVUS) without angiography. MATERIALS/METHODS eighty consecutive patients (median age 69 years (range 25-90): male 72 (90%), female 8 (10%)) underwent endovascular aneurysm repair (AAA 68 (85%), TAA 12 (15%)) using either angiography in 31/80 patients (39%) or IVUS in 49/80 patients (61%) in accordance to the surgeons preference. RESULTS hospital mortality was 2/80 (3%), 1/68 for AAA (2%), 1/12 for TAA (8%), 2/31 for angiography (7%), and 0/49 for IVUS (0.0%: NS). Median quantity of contrast medium was 190 ml (range: 20-350) for angiography versus 0 ml for IVUS (p<0.01). Median X-ray exposure time 24 min (range 9-65 min) versus 8 min (range 0-60 min) for IVUS (p<0.05). No coverage of renal or suprarenal artery orifices occurred in either group. Conversion to open surgery was necessary in 4/80 patients (5%), 1/31 for angiography (3%) and 3/49 patients for IVUS (6%: NS). Early endoleaks were observed in 13/80 patients (16%): 8/31 patients for angiography (26%) versus 5/49 for IVUS (10%: p<0.05): 5/13 endoleaks resolved spontaneously (39%) whereas 8/13 (61%) required additional procedures. CONCLUSIONS IVUS is a reliable tool for EVAR. In most cases, perprocedural angiography is not necessary.
Collapse
Affiliation(s)
- L K von Segesser
- Department for Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, CHUV, Lausanne, Switzerland
| | | | | | | | | |
Collapse
|
21
|
Roffi M, Eberli FR, Wyttenbach R, Gallino A. Percutaneous coronary intervention of the left main trunk in congenitally anomalous single coronary artery. J Invasive Cardiol 2001; 13:808-9. [PMID: 11731695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Anomalous origin of the coronary arteries is infrequent and a single coronary artery is seen even less frequently. Accordingly, few reports have described percutaneous coronary interventions in this anomaly. We report successful balloon angioplasty and stenting of a left main trunk originating from the right coronary artery.
Collapse
Affiliation(s)
- M Roffi
- Swiss Cardiovascular Center Bern, University Hospital, Freiburgstrasse, CH-3010 Bern, Switzerland
| | | | | | | |
Collapse
|
22
|
von Segesser LK, Marty B, Ruchat P, Wicky S, Gallino A, Depairon M, Hayoz D. [Treatment of endovascular aneurysms: the indications widen]. Schweiz Med Wochenschr 1999; 129:1877-83. [PMID: 10627976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Recently, the material available for endovascular aneurysm repair (covered stents and application systems), real time medical imaging and operator experience have significantly improved. Hence, more and more complex vascular lesions, well beyond the original indications, can now be treated by endovascular surgery. Since 1996 our group has implanted 55 endovascular systems in the clinical setting: 45/55 (80%) for classical indications and 11/55 (20%) for extended indications. In the latter group four different endoprosthetic systems were used according to either their performance and availability or the type of lesion to be treated. For the 11 patients undergoing endovascular procedures with extended indications, 6/11 had thoracic aortic lesions (55%) and 5/11 (45%) had aorto-iliac lesions requiring either progressive embolisation of the internal iliac arteries or suprarenal anchorage. For these extended indications hospital mortality was 0/11 (0%). One patient died after hospital discharge. 1/11 patients (9%) had to be converted to open surgery during the interval between iliac embolisation and endovascular repair. There has been no conversion to open surgery during or after the endovascular procedures. Two major endoleaks were detected (2/11: 18%). One has been corrected by an additional covered stent and endovascular repair is planned for the other one. Spontaneously regressive functional hypoperfusion has been observed in 4/5 patients with progressive internal iliac embolisation. There was no irreversible renal insufficiency. Early results of endovascular aneurysm repair for extended indications are promising. Although the long-term outcome is unknown, it can already be said that traditional open surgery can be avoided for a considerable amount of time in an increasing number of patients.
Collapse
|
23
|
Corti R, Alerci M, Tosi C, Tutta P, Hany T, Gallino A. Images in cardiovascular medicine. Cerebral arterial embolism from a protruding atheroma of the aortic arch after a nonpenetrating chest trauma. Circulation 1999; 100:1009-10. [PMID: 10468533 DOI: 10.1161/01.cir.100.9.1009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- R Corti
- Divisions of Vascular Medicine and Cardiology, Ospedale San Giovanni, Bellinzona, Switzerland
| | | | | | | | | | | |
Collapse
|
24
|
|
25
|
Ghielmini M, Zappa F, Menafoglio A, Caoduro L, Pampallona S, Gallino A. The high-dose sequential (Milan) chemotherapy/PBSC transplantation regimen for patients with lymphoma is not cardiotoxic. Ann Oncol 1999; 10:533-7. [PMID: 10416002 DOI: 10.1023/a:1026434732031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The high-dose sequential (HDS) regimen developed in Milan for high-grade lymphomas is very active, but its toxicities are still partly unknown. We evaluated prospectively by doppler-echocardiography the cardiotoxicity of this treatment. PATIENTS AND METHODS Over seven weeks, 20 patients received a sequence of cyclophosphamide, methotrexate, etoposide, mitoxantrone and melphalan, each at its maximum tolerable dose, and the latter in conjunction with autologous peripheral stem-cell transplantation. Echocardiography was performed at baseline, before administration of mitoxantrone and 2, 6 and 12 months after transplantation. The following parameters of the left ventricular systolic and diastolic functions were determined: end diastolic (LVD) and end systolic (LVS) dimensions, the ejection fraction (EF), and the Doppler derived diastolic parameters: peak velocity of the early (E) and late (A) transmitral flow, the E:A ratio, deceleration time of the E wave (DT) and isovolumetric relaxation time (IVRT). A group of 20 normal volunteers served as control. RESULTS At baseline, in comparison to controls, the patients had altered diastolic function (diminished E:A ratio) and, although still within the normal range, a slightly reduced systolic function (EF). During treatment or in the course of follow-up none of the patients showed clinical signs or symptoms of cardiac failure, nor significant changes of systolic or diastolic parameters, apart from a transient increase in the E:A ratio after the first three chemotherapy cycles (from 1.14 to 1.37, P < 0.05). The EF remained constant during, and up to six months after, transplantation, decreasing only slightly after one year (from 62% to 59%, P < 0.05). Using analysis of covariance we showed that the major determinants of baseline cardiac function and of its evolution over time were patient age and gender, with previous treatment with anthracyclines having a minor role. CONCLUSIONS The HDS chemotherapy regimen produced no significant sign of cardiotoxicity up to one year after transplantation in patients with normal baseline cardiac function and no history of cardiac disease, pretreated with up to 550 mg/m2 of doxorubicin.
Collapse
Affiliation(s)
- M Ghielmini
- Department of Oncology, Ospedale San Giovanni, Bellinzona, Switzerland.
| | | | | | | | | | | |
Collapse
|
26
|
von Segesser LK, Lachat M, Leskosek B, Turina M, Gallino A, von Felten A, Pei P. Cardiopulmonary bypass with low systemic heparinization: an experimental study. Perfusion 1999; 5:267-76. [PMID: 10149493 DOI: 10.1177/026765919000500405] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- L K von Segesser
- Clinic for Cardiovascular Surgery, University Hospital, Zürich, Switzerland
| | | | | | | | | | | | | |
Collapse
|
27
|
Abstract
BACKGROUND/AIMS Tacrolimus is metabolized by cytochrome P450 3A4 and 2D6 and has a narrow therapeutic range. We report a serious kinetic interaction between tacrolimus and mibefradil, a potent cytochrome P450 inhibitor. CASE REPORT A 62-year-old women who had undergone liver transplantation was treated with tacrolimus for immunosuppression. For control of blood pressure, the patient was treated with nifedipine. She developed ankle edema, and nifedipine was replaced by mibefradil. Four days later, she presented with mental confusion, renal failure, and hyperglycemia, compatible with tacrolimus toxicity. In agreement with this assumption, the tacrolimus blood concentration was 100 ng/ml. Mibefradil and tacrolimus were both stopped, and the patient recovered within 1 week. Eight days after stopping mibefradil, tacrolimus was restarted at the same dosage and the subsequent plasma concentrations remained in the therapeutic range. CONCLUSIONS Mibefradil increases the tacrolimus blood concentration by inhibiting its metabolism and should, therefore, not be used in patients treated with tacrolimus.
Collapse
Affiliation(s)
- S Krähenbühl
- Institute of Clinical Pharmacology, University of Berne, Switzerland.
| | | | | | | |
Collapse
|
28
|
Corti R, Ferrari C, Roberti M, Alerci M, Pedrazzi PL, Gallino A. Spiral computed tomography: a novel diagnostic approach for investigation of the extracranial cerebral arteries and its complementary role in duplex ultrasonography. Circulation 1998; 98:984-9. [PMID: 9737518 DOI: 10.1161/01.cir.98.10.984] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND For the detection of atherosclerotic lesions of the extracranial cerebral arteries, duplex ultrasonography (US) is an established operator-dependent method, whereas arteriography is associated with the not-insignificant risk of embolic complications. Spiral CT is a promising novel diagnostic tool that allows noninvasive, operator-independent diagnosis of obstruction of extracranial cerebral arteries. The aim of our prospective study was to evaluate in a clinical setting the complementary role of duplex US and spiral CT. METHODS AND RESULTS We compared the results obtained independently by spiral CT and duplex US in 59 consecutive patients with clinical suspicion of an obstructive lesion affecting the carotid arteries. We analyzed a total of 354 segments from the extracranial carotid arteries, including the common, internal, and external carotid arteries. A total of 4 complete occlusions, 38 severe stenoses (70% to 99%), and 32 moderate stenoses (30% to 69%) were concordantly identified by means of duplex US and spiral CT. In 5 cases in which duplex US did not allow sufficient evaluation of the carotid artery because of a poor US window or severe calcification, spiral CT allowed identification and correct measurement of the stenotic lesion. The comparison of the percentage of stenosis with both methods was good (r=0.91, P=0.024). CONCLUSIONS Our results indicate that spiral CT of the extracranial cerebral arteries is a promising noninvasive complementary and non-operator-dependent examination. Its application is particularly attractive in cases in which duplex US is not reliable (ie, severe kinking, severe calcification, short neck, and high bifurcation) and particularly when an overall view of the vascular field is required.
Collapse
Affiliation(s)
- R Corti
- Division of Cardiology and Vascular Medicine, Ospedale San Giovanni, (E.O.C.) Bellinzona, Switzerland
| | | | | | | | | | | |
Collapse
|
29
|
Colleoni M, Martinelli G, Beretta F, Marone C, Gallino A, Fontana M, Graffeo R, Zampino G, De Pas T, Cipolla G, Martinoni C, Goldhirsch A. Intracavitary chemotherapy with thiotepa in malignant pericardial effusions: an active and well-tolerated regimen. J Clin Oncol 1998; 16:2371-6. [PMID: 9667253 DOI: 10.1200/jco.1998.16.7.2371] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Malignant pericardial effusion, although highly variable, is an uncommon complication of cancer. It is often associated with symptoms like dyspnea, chest pain, and cough, which may be severe and disabling. We analyzed the results of our current treatment policy to evaluate the effectiveness and tolerance of a new approach for this disorder. PATIENTS AND METHODS Patients with malignant pericardial effusions were treated with intracavitary thiotepa (15 mg on days 1, 3, and 5) through an indwelling pericardial cannula after extraction of as much pericardial fluid as possible on day 0. Responses were assessed by clinical examination, computed tomographic (CT) scan, and echocardiography before treatment, 1 month after treatment, and every 2 months thereafter. Twenty-three patients with malignant symptomatic pericardial effusion were treated and all were assessable for effectiveness and tolerance of the procedure. RESULTS Nine patients with breast cancer, 11 with lung cancer, two with an unknown primary tumor, and one with metastatic melanoma were treated. In all but three patients, systemic medical treatment was started after completion of intracavitary therapy. Nineteen patients responded to treatment (83%; 95% confidence interval, 61% to 95%) with a rapid improvement of symptoms. The median time to pericardial effusion progression was 8.9 months (range, 1 to 26). No significant side effects were registered, except one patient who had transient grade III thrombocytopenia and leukopenia and one patient who had grade I leukopenia. CONCLUSION A short course of intracavitary treatment with thiotepa is highly effective and well tolerated in the treatment of malignant pericardial effusion.
Collapse
Affiliation(s)
- M Colleoni
- Division of Medical Oncology and Service of Cardiology, European Institute of Oncology, Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Fatio R, Sütsch G, Mayer K, Follath F, Corti R, Gallino A, Kiowski W. Posttransplant lymphoproliferative disorders in cardiac transplant patients. Transplant Proc 1998; 30:1118-20. [PMID: 9636453 DOI: 10.1016/s0041-1345(98)00175-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- R Fatio
- Division of Cardiology, University Hospital Zürich, Switzerland
| | | | | | | | | | | | | |
Collapse
|
31
|
Oechslin E, Brunner-LaRocca HP, Solt G, Sütsch G, Jenni R, Gallino A, Mayer K, Vogt P, Künzli A, Turina M, Kiowski W. Prognosis of medically treated patients referred for cardiac transplantation. Int J Cardiol 1998; 64:75-81. [PMID: 9579819 DOI: 10.1016/s0167-5273(98)00007-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess prognosis and factors influencing survival of transplant candidates in whom continued medial therapy was recommended in comparison to that of immediately listed patients. METHODS Retrospective analysis of clinical, echocardiographic and hemodynamic data as related to survival or listing for transplantation of medically treated transplant candidates. PATIENTS 160 patients considered 'too well' for cardiac transplantation and 133 patients immediately listed for transplantation. RESULTS Forty-one of the medically treated patients deteriorated clinically and were listed after 10.7+/-12.3 months after initial evaluation. Mid-term prognosis (2 years) of patients never listed was comparable to that of immediately listed patients (74% vs. 70%) but long-term prognosis (5 years) was worse (41% vs. 54%, p<0.001). Cardiothoracic ratio and pulmonary capillary wedge pressure were independent predictors of survival (multivariate analysis) in patients whose NYHA class and physical working capacity improved and cardiothoracic ratio decreased significantly after adjustment of medical therapy. CONCLUSIONS Mid-term prognosis of selected patients considered 'too well' for transplantation is comparable to patients immediately listed. Lower left ventricular filling pressures, smaller hearts on chest X-ray on initial evaluation, and improvement of symptoms during follow up may identify a subgroup of patients who do well on optimized therapy.
Collapse
Affiliation(s)
- E Oechslin
- Department of Internal Medicine, University Hospital, Zürich, Switzerland
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
|
33
|
Vassalli G, Gallino A. Endothelial dysfunction and accelerated coronary artery disease in cardiac transplant recipients. Microcirculation Working Group, European Society of Cardiology. Eur Heart J 1997; 18:1712-7. [PMID: 9402444 DOI: 10.1093/oxfordjournals.eurheartj.a015164] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- G Vassalli
- Division de Cardiologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | |
Collapse
|
34
|
Plebani G, Bonvini R, Llamas M, Tutta P, Gallino A. 1.P.347 Are extensive preoperative investigations in pts undergoing coronary or peripheral vascular surgery necessary? Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)88524-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
35
|
Tkebuchava T, von Segesser LK, Gallino A, Dirsch O, Turina MI. Cardiac papillary fibroelastoma excision combined with reconstructive surgery. Jpn Heart J 1997; 38:457-62. [PMID: 9290579 DOI: 10.1536/ihj.38.457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Three cases of cardiac papillary fibroelastomas are described. Two-dimensional echocardiography detected the tumors in the mitral valve, the cordae tendinae and in the apex of the left ventricle--a unique location. The tumor excisions were combined with bypass operation, mitral valve reconstruction, repair of cordae tendinae and Maze-procedure. The three patients are doing well after surgery.
Collapse
Affiliation(s)
- T Tkebuchava
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland
| | | | | | | | | |
Collapse
|
36
|
Abstract
BACKGROUND In recent years, there has been an increasing proportion of candidates for heart transplantation who have sustained one or several previous cardiac operations. This study analyzes the perioperative management and the long-term survival of patients undergoing orthotopic heart transplantation as a redo operation and compares the results with those obtained in patients undergoing transplantation as the first cardiac operation. METHODS From October 1985 to October 1994, 204 heart transplantations were performed in 202 patients. Thirty-eight transplantations were performed in patients who had undergone prior cardiac operations because of coronary artery disease (n = 21) and valvular disease (n = 8) as well as one or several palliative or corrective procedures because of complex congenital heart disease (n = 9). These 38 patients were compared in a case-control fashion with 76 patients who underwent orthotopic cardiac transplantation as a primary cardiac procedure during the same period and using similar techniques. The majority of preoperative variables (hemodynamics, inotropic support, liver and renal function, coagulation, and priority to transplantation) were comparable in the two groups of patients. Mean age was significantly younger in the group of patients with a previous operation (42.2 +/- 9.5 versus 50.1 +/- 7.3 years; p < 0.001). RESULTS Except the problem of more fastidious hemostasis, which is nowadays under better control since aprotinin has been routinely administered, the results show no significant difference in term of perioperative risk (hospital mortality: 5.2% in study group versus 7.8% in the control group) and long-term outcome. The 1-year survival rate was 92.7% +/- 3.6% in the study group versus 90.8% +/- 3.6% in the control group, and the 5-year survival rate was 79.4% +/- 4.5% versus 74.8% +/- 7.5%, respectively. CONCLUSIONS These results are very acceptable and confirm the fact that carefully selected candidates for transplantation are not exposed to a particularly high perioperative risk when a prior cardiac operation has been performed. The incidences of early and late rejection episodes as well as the numbers of postoperative infections are similar in the two groups. Although multiple prior procedures do constitute significant risk factors for perioperative morbidity and mortality in isolated lung and heart-lung transplantation, this is not the case in heart transplantation.
Collapse
Affiliation(s)
- T Carrel
- Clinic for Cardiovascular Surgery, University Hospital Zürich, Switzerland
| | | | | | | | | |
Collapse
|
37
|
Abstract
BACKGROUND Coronary flow reserve (CFR) is reduced in a majority of patients after heart transplantation (HTx). Pharmacological interventions, however, provide only limited information on CFR under physiological conditions. Thus, CFR during exercise was evaluated in the present study. METHODS AND RESULTS Coronary angiography was performed at rest and during supine bicycle exercise in 35 patients early (2 to 3 months; n = 10) or late (1 to 6 years; mean, 2.5 years; n = 25) after HTx and in 8 controls (C). CFR was determined by parametric imaging after administration of 10 mg intracoronary papaverine, during exercise, and after 1.6 mg sublingual nitroglycerin. Epicardial coronary artery size was measured by quantitative coronary angiography. CFR after papaverine was normal early (3.6 +/- 0.5 versus C, 3.6 +/- 0.7; P = NS) and late (3.8 +/- 1.3 P = NS) after HTx. During exercise, CFR was normal early (3.1 +/- 0.6 versus C, 3.9 +/- 0.9; P = NS) but decreased late (2.3 +/- 0.6; P < .01) after HTx. The increase in coronary cross-sectional area during exercise was also diminished late after HTx (14 +/- 10% versus C, 22 +/- 10%; P < .05). Both exercise-induced CFR (r = -.39, P < .05) and coronary vasodilation (r = -.44, P < .01) were inversely correlated with time after HTx. CONCLUSIONS CFR during exercise is normal early but reduced late after HTx, whereas CFR after papaverine administration is maintained. This difference between physiological and pharmacological vasodilation suggests progressive endothelial dysfunction after HTx.
Collapse
Affiliation(s)
- G Vassalli
- Department of Internal Medicine, Cardiology, University Hospital, Zurich, Switzerland
| | | | | | | | | | | |
Collapse
|
38
|
Oechslin E, Kiowski W, Schneider J, Follath F, Turina M, Gallino A. Pretransplant malignancy in candidates and posttransplant malignancy in recipients of cardiac transplantation. Ann Oncol 1996; 7:1059-63. [PMID: 9037365 DOI: 10.1093/oxfordjournals.annonc.a010499] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Malignancy is generally considered a contraindication for cardiac transplantation, whereas secondary malignancy has been described under chronic immunosuppression. PATIENTS AND METHODS We report here the frequency of malignancy encountered among the 495 patients evaluated at our cardiac transplant centre as well as the incidence and the course of post-transplant malignancy among 129 consecutive patients who underwent cardiac-transplantation, with a subsequent minimum follow-up of 6 months. RESULTS A total of 10 out of 495 patients (2%) evaluated for heart transplantation presented with a history of previous malignancy: 3 of them underwent transplantation (2 survive, 1 died) whereas in the remaining 7 patients neoplasia was considered a contraindication for cardiac transplantation, and all 7 died (4 cardiac, 3 tumor-related deaths). Post-transplant malignancy was diagnosed in 10 of 129 patients (9%) 35 +/- 15 months after transplantation (6 skin cancers, 1 lymphoproliferative disease, 3 solid tumors). No significant association was found between post-transplant malignancy and primary prophylaxis with antithymocyte globulin (ATG) or murine antihuman T-cell monoclonal antibodies (OKT3). CONCLUSION These results confirm that pre-transplant malignancy is not an absolute contraindication for cardiac transplantation and that post-transplant follow-up must include careful monitoring of post-transplant malignancy.
Collapse
Affiliation(s)
- E Oechslin
- Department of Internal Medicine, University Hospital, Zurich, Switzerland
| | | | | | | | | | | |
Collapse
|
39
|
Vassalli G, Kaski JC, Tousoulis D, Kiowski W, Turina M, Follath F, Gallino A. Low-dose cyclosporine treatment fails to prevent coronary luminal narrowing after heart transplantation. J Heart Lung Transplant 1996; 15:612-9. [PMID: 8794036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Cyclosporine has been reported to induce endothelial dysfunction, arterial vasculitis, and accelerated atherosclerosis in experimental models. The purpose of the present study was to evaluate whether low-dose cyclosporine treatment started 1 year after heart transplantation reduces graft coronary artery narrowing compared with conventional cyclosporine doses. METHODS One year after heart transplantation, 30 patients were randomly assigned to receive low-dose cyclosporine A (whole-blood polyclonal cyclosporine target trough levels 200 to 400 micrograms/L; group A; n = 15) or usual cyclosporine dosage (target levels 400 to 600 micrograms/L; group B; n = 15). Proximal and distal diameters of the left anterior descending, circumflex, and right coronary arteries were measured by quantitative coronary angiography at baseline (1 year after transplantation) and at 2 and 3 years after transplantation. RESULTS One major cardiac event occurred in group A (retransplantation) and two in group B (sudden deaths). Moderate to severe allograft rejection (International Society for Heart and Lung Transplantation score 3A or higher) occurred in seven patients in group A and five in group B during the study period. Mean biopsy sample rejection score during the same period was increased in group A compared with that in group B (1.44 +/- 0.63 versus 1.05 +/- 0.59; p < 0.05). New angiographic evidence of vascular disease was observed in four patients of group A and in one patient of group B. Proximal coronary artery diameter was slightly, although not significantly, reduced in both groups at follow-up angiography. Distal segments showed a significant diameter reduction, which was greater in group A than in group B (-9.7% +/- 1.1% and -5.2% +/- 1.3%, respectively; p < 0.05). CONCLUSIONS Cyclosporine dose reduction started 1 year after heart transplantation is ineffective in reducing coronary luminal narrowing and may be associated with an increased prevalence of cardiac allograft vasculopathy, especially in the distal coronary tree. Low-dose cyclosporine treatment may slightly enhance the risk of allograft rejection. Further investigations are needed to evaluate the effects of cyclosporine dose reduction started at an earlier time after heart transplantation.
Collapse
Affiliation(s)
- G Vassalli
- Department of Medicine, Cardiology, University Hospital, Zurich, Switzerland
| | | | | | | | | | | | | |
Collapse
|
40
|
Gallino A, Maggiorini M, Kiowski W, Martin X, Wunderli W, Schneider J, Turina M, Follath F. Toxoplasmosis in heart transplant recipients. Eur J Clin Microbiol Infect Dis 1996; 15:389-93. [PMID: 8793397 DOI: 10.1007/bf01690095] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In cardiac transplant recipients, infection with Toxoplasma gondii may be transmitted with the transplanted organ to immunosuppressed recipients or may be due to reactivation under immunosuppression in cases of pretransplant infection. In the present study the incidence of infection with Toxoplasma gondii and the clinical presentation of the infection in 121 consecutive heart transplant recipients were investigated. Data on IgG and IgM antibodies for Toxoplasma gondii measured by a semiquantitative microparticle immunoassay of donors and recipients were collected prospectively in 121 patients. Infection with Toxoplasma gondii was defined as IgM seroconversion with proven pre-transplant seronegativity (primary infection) or at least a fourfold increase of IgG antibodies (reactivation). Infection with Toxoplasma gondii occurred in 16 of 121 patients (13%) whereas overt clinical disease occurred in 5 of 121 patients (4%). Organ-transmitted infection was more frequent (11/18, 61%) and more often associated with acute disease than reactivation of latent infection (5/69 patients, 7%) (p < 0.01), although one case of Toxoplasma retinochoroiditis occurred in a patient with recrudescence of latent pretransplant infection. Treatment with pyrimethamine and sulfadiazine was efficient in all patients with acute disease and in controlling disease in patients with evidence of acute infection.
Collapse
Affiliation(s)
- A Gallino
- Department of Internal Medicine, University Hospital, Zurich, Switzerland
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Gallino A. [Does heart disease recur following heart transplantation?]. Ther Umsch 1995; 52:581-4. [PMID: 7502262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The long follow-up after heart transplantation is influenced by the occurrence of graft-coronary artery disease. This complication remains a diagnostic, prognostic and therapeutical dilemma. This short review gives an insight into the principal aspects concerning this complication.
Collapse
|
42
|
Carrel T, Kujawski T, Zünd G, Schwitter J, Amann FW, Gallino A, Bertel O, Jenni R, Turina M. The internal mammary artery malperfusion syndrome: incidence, treatment and angiographic verification. Eur J Cardiothorac Surg 1995; 9:190-5; discussion 196-7. [PMID: 7605642 DOI: 10.1016/s1010-7940(05)80143-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Internal mammary artery (IMA) malperfusion syndrome is caused by an acute imbalance between myocardial demand and nutritional support through the mammary artery. In a consecutive series of 2326 isolated myocardial revascularizations-with at least one IMA to the left anterior descending branch (LAD) in 91.3% (2125/2326)-we identified 45 patients (1.9%) with a perioperative course suggesting IMA malperfusion syndrome. Additional saphenous vein graft to the distal segment of the LAD was performed during normothermic ventricular fibrillation in all patients. Hospital mortality was 4.4% (2/45), intra-aortic balloon pumping was required in 15.5% (7/45) and anterior myocardial infarction occurred in 28.8% (13/45). Coronary angiography was performed in all survivors between 3 and 24 months postoperatively. Wide patent IMA graft and patent saphenous vein graft were observed in 56% (24/43), narrowed but patent IMA graft and patent vein graft in 35% (15/43), while patent vein graft and not visualized IMA in 7% (3/43); in one patient with severely diseased peripheral LAD, no flow could be demonstrated in the IMA graft or in the additional vein graft (1/43, 2.4%). No major differences were found between early and late coronary angiography in these patients. Additional vein graft to distal LAD is the treatment of choice in acute IMA malperfusion syndrome. Despite patent vein graft with superior blood flow, early and late postoperative IMA flow to LAD is maintained in the majority of patients.
Collapse
Affiliation(s)
- T Carrel
- Clinic for Cardiovascular Surgery, University Hospital Zürich, Switzerland
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Maggiorini M, Gallino A, Schmid E. Prostaglandine E1 for assessing reversibility of pulmonary hypertension prior to cardiac transplantation. J Cardiothorac Vasc Anesth 1994. [DOI: 10.1016/1053-0770(94)90556-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
44
|
Waser M, Maggiorini M, Lüthy A, Laske A, von Segesser L, Mohacsi P, Opravil M, Turina M, Follath F, Gallino A. Infectious complications in 100 consecutive heart transplant recipients. Eur J Clin Microbiol Infect Dis 1994; 13:12-8. [PMID: 8168553 DOI: 10.1007/bf02026117] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Clinical and laboratory data on infectious complications in 100 consecutive heart transplant recipients were analyzed retrospectively. The mean length of follow-up was 651 +/- 466 days. All patients received a basic immunosuppressive regimen including cyclosporine (whole blood target trough level 400-600 micrograms/l), azathioprine (1 mg/kg/day) and prednisone (0.15 mg/kg/day). Early rejection prophylaxis consisted of polyclonal rabbit antithymocyte globulin (ATG) (4 mg/kg/day for 4 days) in the first 57 patients and monoclonal murine OKT-3 (5 mg/day for 14 days) in the remaining patients. The primary cause of death was infection in three patients and rejection in 16 (p < 0.001). The incidence of infection was 0.96/patient/year (n = 179); 95 infections were nosocomial (53%), 47 community-acquired (26%) and 37 opportunistic (21%). The number of hospitalizations due to infections was fewer than that due to rejection (53 versus 246 respectively, p < 0.0001), but the mean length of hospital stay was longer in the first group (13.85 +/- 10.92 days versus 3.48 +/- 2.28 days, p < 0.001). Previous early rejection prophylaxis with OKT-3 was associated with a greater number of opportunistic and nosocomial infections compared to prophylaxis with ATG (p < 0.05), as was treatment with ATG and steroid pulses compared to steroid pulses alone in cases of opportunistic infection (p < 0.05).
Collapse
Affiliation(s)
- M Waser
- Division of Cardiology, University Hospital, Zürich, Switzerland
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
|
46
|
Waser M, Maggiorini M, Binswanger U, Keusch G, Carrel T, von Segesser L, Gallino A, Turina M. Irreversibility of cyclosporine-induced renal function impairment in heart transplant recipients. J Heart Lung Transplant 1993; 12:846-50. [PMID: 8241226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The use of cyclosporine therapy for heart transplant recipients has been associated with a significant improvement of graft survival. Renal function impairment is a frequent finding in patients chronically treated with cyclosporine. The purpose of this prospective randomized study was to establish renal function in a group of heart transplant recipients receiving chronic cyclosporine treatment and to test the hypothesis of reversibility of cyclosporine-induced nephropathy by late reduction of cyclosporine. A total of 28 patients who underwent operation at least 18 months before this study began were randomly assigned to either group A (n = 14), in which the whole-blood polyclonal cyclosporine target trough level was reduced from 400 to 600 micrograms/L to 200 to 400 micrograms/L, and group B (n = 14), in which the level was maintained at 400 to 600 micrograms/L. Renal and cardiac function were assessed by paraaminohippuric acid, inulin and lithium clearances and heart catheterization, respectively, at entry and 4 months later. Cellular rejection in the transplanted heart was monitored by at least four endomyocardial biopsies every 14 days with the histologic Texas scale (grading: 0 to 10). In heart recipients renal blood flow (592 +/- 202 ml/min/1.73 m2) and glomerular-filtration rate (74 +/- 33 ml/min/1.73 m2) were significantly lower (p < 0.01), and mean arterial blood pressure (109 +/- 13 mm Hg) and renal vascular resistance (22.4 +/- 9 mm Hg/dl/min/1.73 m2) were significantly higher than the corresponding values in normal controls (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- M Waser
- Department of Medicine, University Hospital of Zurich, Switzerland
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Affiliation(s)
- R Maire
- Division of Medicine, Kantonsspítal, Lucerne, Switzerland
| | | | | |
Collapse
|
48
|
Baumann PC, Meyer BJ, Maggiorini M, Ha HR, Gallino A, Follath F. Hemodynamic effects and concentration-effect relationship of a graded infusion of piroximone in patients with severe heart failure. J Cardiovasc Pharmacol 1993; 21:489-95. [PMID: 7681513 DOI: 10.1097/00005344-199303000-00021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Piroximone is a new phosphodiesterase III inhibitor that combines inotropic and vasodilator properties. To elucidate the optimal dose regimen and the dose-concentration-effect relationships, we studied eight patients with congestive heart failure of New York Heart Association class IV during a continuous multistage infusion over a 24-h period followed by a 4-h washout. After a bolus of 0.5 mg/kg, infusions at a rate of 2.5, 5.0, and 10.0 micrograms/kg/min for 8 h each were given to determine the maintenance dose of piroximone required to achieve an increase in cardiac index > or = 30%. Serial assessment of hemodynamics, plasma piroximone levels, and ventricular ectopic beats was performed. Following the loading dose and at higher infusion rates (5 and 10 micrograms/kg/min) Piroximone produced significant hemodynamic changes compared to baseline, i.e., a maximum increase in cardiac index from 2.2 +/- 0.4 to 3.6 +/- 0.8 L/min/m2 (67 +/- 21%), decreases in right atrial pressure from 14 +/- 3 to 9 +/- 3 mm Hg (40 +/- 16%), pulmonary capillary wedge pressure from 29 +/- 5 to 23 +/- 7 mm Hg (28 +/- 18%), pulmonary vascular resistance from 249 +/- 93 to 151 +/- 59 (45 +/- 19%), and systemic vascular resistance from 1,330 +/- 442 to 752 +/- 272 dyn s/cm5 (44 +/- 19%). Piroximone increased the heart rate by 10% at the highest dose and produced a decrease in mean arterial pressure by 13%. There was a slight increase in ventricular ectopy in two patients (2.2 and 3 VPBs/min) and no change in the remaining six.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- P C Baumann
- Division of Cardiology, University Hospital, Zurich, Switzerland
| | | | | | | | | | | |
Collapse
|
49
|
Affiliation(s)
- M Pasic
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland
| | | | | | | | | | | | | |
Collapse
|
50
|
Laske A, Gallino A, Carrel T, Niederhäuser U, von Segesser LK, Turina MI. Cytomegalovirus infection and prophylaxis in heart transplantation. Transplant Proc 1993; 25:1427-8. [PMID: 8382870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- A Laske
- Department of Surgery, University Hospital Zürich, Switzerland
| | | | | | | | | | | |
Collapse
|