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Revista Uruguaya de Cardiología

On-line version ISSN 1688-0420

Abstract

GRUN, SANTIAGO et al. Retrasplante cardíaco: a propósito del primer caso en Uruguay. Rev.Urug.Cardiol. [online]. 2006, vol.21, n.2, pp.124-130. ISSN 1688-0420.

SUMMARY Graft vascular disease represents the main restrictive factor in the survival of heart transplantation patients. Cardiac retransplantation remains the sole alternative for the treatment of severe graft vascular disease. We analyze the first clinical case of cardiac retransplantation in Uruguay, as well as to provide some considerations regarding the indication for the procedure and its results. We consider a 21 year old male patient, who underwent cardiac transplantation in July 1997 and showed a good evolution until March 2004, when symptoms of cardiac congestive insufficiency became evident. Through echocardiography, we noticed a severe decrease in the ejection fraction for the left ventricle. Through cineagiography, we remarked severe injury in the middle section of the descending anterior artery. We performed an angioplasty with sirolimus stent, followed by an intially positive evolution of the patient and function improvement, later followed by functional symptoms of congestive cardiac insufficiency 5 months after the procedure. New cineagiography studies confirmed the presence of a severe wound in three vessels, similarly to graft vascular disease signs. The echocardiographic studies showed the persistence of a severe decrease in the left ventricular function, with an function evolution class III-IV. It represents a case of severe and rapidly progressive graft vascular disease, (6 months) with a dilated phase presenting serious decrease in left ventricular ejection fraction. We discarted other options regarding revascularization, therefore included the patient in the waiting list for urgent retransplantation. In october 2004 the retransplantation procedure was performed without complications and with a positive evolution. The first patient we submitted to retransplantation shows, 19 months after the procedure was performed, no symptomatology of rejection nor other negative symptoms, now leads a normal life, and shows echocardiographic studies with LVEF of 68%, a biopsy with not rejection, and normal coronary arteries.

Keywords : CARDIAC RETRANSPLANTATION; HEART FAILURE; CONGESTIVE; CASE REPORTS; PUBLICATION TYPE.

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