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Background: Diagnosis of rejection is a major objective in the management of heart transplant recipients. It has been reported that one-third of protocol biopsies in asymptomatic, biochemically stable organ transplant recipients in the first 6 months show unsuspected subclinical graft rejection., Case Report: We present the case of a 43-year-old man suffering from dilated cardiomyopathy who underwent orthotropic heart transplantation. The patient was admitted for a protocol endomyocardial biopsy and magnetic resonance imaging (MRI) on the 4th postoperative month as a protocol procedure. The examination revealed clinical status NYHA I with no signs of fatigue, diminution of exercise tolerance, or shortness of breath. His body temperature was not raised. He was referred for endomyocardial biopsy and cardiovascular magnetic resonance (CMR) imaging. CMR imaging showed good left and right ventricle function and contractility. T2 imaging revealed increased signal in the area of the right ventricular free wall, seen both in 4-chamber and short axis views. The patient underwent an endomyocardial biopsy, which demonstrated diffuse infiltrate with multifocal miocyte damage and cellular edema recognized as acute rejection (3a ISHLT grade). Consequently, he was treated with parenteral methylprednisolone administration. The CMR study performed after 1 week of therapy showed that the signal intensity of the edematous areas was significantly decreased. Repetitive endomyocardial biopsy revealed no signs of rejection., Conclusions: CMR can be helpful in graft monitoring following heart transplantation. It gives a whole-heart perspective that can be competitive with and/or complementary to endomyocardial biopsy. As a noninvasive study it can be applied more often and facilitates diagnosis of asymptomatic rejection episodes.

Background: In recent years, patients over 80 years of age have been a growing group of individuals referred to cardiac surgeons. They pose a serious challenge and usually require a multidisciplinary approach., Aim: The aim of this study was to evaluate the early and late outcomes of cardiosurgical treatment of patients over 80 years of age suffering from coronary artery disease and aortic stenosis., Material and Methods: The study involved 96 patients aged over 80 years treated between January, 2004 and December, 2012. The mortality and morbidity in the early postoperative period, as well as throughout the follow-up period, were analyzed., Results: The majority of patients underwent isolated coronary artery bypass grafting (CABG) (58.3%; Group I), while 29.2% of them underwent an isolated aortic valve replacement (AVR) (Group II). Combined procedures (CABG + AVR) were carried out in 12.5% of patients (Group III). The mean operational risk calculated according to the logistic EuroSCORE was 11.6%, 11.9%, and 9.5%, respectively in Group I, Group II and in Group III. In the early postoperative period, 4 patients died (all from Group I). The 30-day mortality rate was 4.2% and the morbidity rate was 56.3%. During the post-discharge follow-up period that lasted from 1 to 100 months, 4 patients died (2 from Group I and 2 from Group III). The 2-year probability of survival was 91.9 ± 3.0%. During the last follow-up clinical assessment, half of the patients were asymptomatic., Conclusions: The perioperative mortality of the patients is acceptably and markedly lower than that predicted by the logistic EuroSCORE calculator. However, the complication rate, particularly in the early postoperative period, is relatively high.

Background: Sildenafil, a phosphodiesterase-5 inhibitor, has been shown to decrease pulmonary vascular resistance (PVR) in patients with heart failure. The purpose of the study was to evaluate the effect of sildenafil on clinical status and pulmonary vascular reactivity in patients with congestive heart failure., Material and Methods: We enrolled 20 patients (18 men and 2 women, mean age 51 ± 12 years, diagnosed with congestive heart failure and pulmonary hypertension. This was a prospective, single-center study. Patients were treated with sildenafil 25 mg TDS for 12 months. Protocol included NYHA evaluation and repeated echocardiography, cardiac pulmonary stress tests, and right- sided catheterization., Results: Initially, there were 16 (80%) patients in III NYHA status and 4 (20%) patients in II NYHA. After 12 months, 8 patients were in NYHA III (40%) status and 12 patients in NYHA II (60%). Peak oxygen consumption increased from 12 ± 3 ml/kg/min to 19 ± 4 ml/kg/min after 1-year therapy (p<0.001). The cardiac index increased from 3.1 ± 0.6 L/min/m2 to 3.6 ± 0.4 L/min/m2 (p<0.05). Pulmonary vasculature resistance decreased after 1-year therapy (4.7 ± 1 vs. 1.6 ± 0.5 Woods units (p<0.005) comparing to initials. Mean pulmonary artery pressure decreased to 23 ± 6 mmHg from 42 ± 5 mmHg (p<0.001) after 1-year therapy., Conclusions: One-year sildenafil therapy effectively improved clinical status and pulmonary vascular resistance in patients diagnosed with congestive heart failure.