Other transplantLater Evolution After Cardiac Transplantation in Chagas’ Disease
Section snippets
Methods
From March 1985 to April 2004 (19 years), 285 patients with cardiomyopathy in an advanced phase underwent cardiac transplantation with 59 (20.7%) of them having Chagas’ disease. After dilated and ischemic cardiomyopathy this disease represented the third cause of heart failure among transplantation indications.
The patients were between 11 and 63 years old (44.4 ± 55.2 months), including 41 (63.5%) men. The overall observation period was between 4 days and 204 months (44.4 ± 55.2 months). Fifty
Results
After the transplantations, the native hearts were subjected to pathological examination that showed chronic myocarditis in 57 (96.6%) hearts; narrow-necked left ventricule in 39 (66.1%); intracavity thrombus in 18 (30.5%); and the amastigote stages of T cruzi in 12 (20.3%). In the first phase of experience (10 patients), the immediate doses of cyclosporine were between 5 and 10 mg/kg/d; the average was 6.70 ± 1.77 mg/kg/d. In the second phase (49 patients), the initial cyclosporine doses were
Discussion
Since the original description of Chagas’ disease in 1911, a great number of improvements have been made in the understanding of its physiopathology.9 The drugs used against the acute phase have low efficacy without the capacity to definitely eradicate the protozoa from the patient. Orientation of public health to control the disease is the most effective way. The cardiac manifestations of Chagas’ disease are the most serious. They are progressive to death in the final phase of the disease. The
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Cited by (61)
Advanced Therapies for Ventricular Arrhythmias in Patients With Chagasic Cardiomyopathy: JACC State-of-the-Art Review
2021, Journal of the American College of CardiologyCitation Excerpt :Cardiac transplantation is an option for patients with refractory heart failure and VAs linked to CCC. A cohort of 285 CCC patients undergoing transplantation in Brazil reported 47% use of inotropes or ventricular assist device at the time of transplantation, and a main indication for transplantation consisted of arrhythmia refractory to medical treatment (97). A more contemporary cohort of 11 patients in southern California reported a history of VT in 46% of patients, and 73% required inotropes or ventricular assist devices at the time of transplantation (98).
Chagas cardiomyopathy and heart failure: From epidemiology to treatment
2020, Revista Portuguesa de CardiologiaChagas disease: Historic perspective
2020, Biochimica et Biophysica Acta - Molecular Basis of DiseaseChronic Chagas Heart Disease Management: From Etiology to Cardiomyopathy Treatment
2017, Journal of the American College of CardiologyHeart Transplantation for Chagas Cardiomyopathy
2017, Journal of Heart and Lung Transplantation