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Image in Cardiology
Early restrictive-constrictive physiology in a cardiac allograft recipient
Fisiologia restritiva-constritiva em recetor de aloenxerto cardíaco
Carlos Ortiz-Bautista
Autor para correspondência
ortiz.bautista.carlos@gmail.com

Corresponding author.
, Elena Puerto García-Martín, Laura Morán-Fernández, Inés Ponz-de Antonio, Adriana Rodríguez-Chaverri, Juan F. Delgado-Jiménez
Unidad de Insuficiencia Cardiaca, Trasplante e Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0080" class="elsevierStylePara elsevierViewall">A 57-year-old man with personal history of dilated ischemic cardiomyopathy and advanced heart failure was referred to our unit for cardiac transplantation evaluation&#46; After ruling out contraindications&#44; elective cardiac transplantation was performed without postoperative complications&#46; The patient was discharged from the intensive care unit to the general ward with severe volume overload&#44; so intravenous furosemide was started&#46; Central venous pressure assessment during orthostatism revealed a prominent v wave and abrupt y descent &#40;Video 1&#41;&#46; Two-dimensional echocardiography showed normal allograft function&#46; Endomyocardial biopsy was performed by protocol and showed no evidence of cellular or humoral rejection&#46; At the same time&#44; right heart catheterization showed a prominent v wave and abrupt y descent in right atrial pressure &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#44; left&#44; red arrows&#41; and a rapid increase in right ventricular pressure during early diastole &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#44; right&#44; red arrows&#41;&#44; which confirmed the restrictive-constrictive physiology suspected from the physical examination&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">A characteristic development of hemodynamics in heart and heart-lung transplants that mimics restrictive myocardial disease has been previously reported&#46; Patients fulfill criteria for restrictive-constrictive physiology if they have increased diastolic pressure&#44; an abrupt and rapid rise in pressure in early diastole&#44; and rapid filling wave exceeding 4 mmHg&#46; This hemodynamic pattern has been previously reported in patients with acute moderate cellular rejection&#46; However&#44; during the first weeks after heart transplantation&#44; a restrictive-constrictive physiology may be present even in the absence of cellular rejection&#46; This case shows that restrictive-constrictive physiology can be routinely assessed by physical examination&#46;</p><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "texto" => "<p id="par0095" class="elsevierStylePara elsevierViewall">Funding for this study was provided by <span class="elsevierStyleGrantSponsor" id="gs1">Instituto de Salud Carlos III&#44; Spanish Ministry of Economy and Competitiveness</span>&#44; through Red de Investigaci&#243;n Cardiovascular&#46;</p>"
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Informação do artigo
ISSN: 08702551
Idioma original: Inglês
DOI:10.1016/j.repc.2016.07.017
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