title: Heart transplantation in endstage rheumatic heart disease-experience of an endemic area.
abstract: BACKGROUND
  Rheumatic heart disease (RHD) remains a significant cause of cardiovascular disease in developing countries. The nonsuppurative cardiovascular sequel of group A streptococcal infection is sustained inflammatory and immune reactions toward the myocardium and valves. This study attempted to determine the long-term outcome of heart transplantation in endstage RHD patients.Methods and Results:The 23 patients with endstage RHD at National Taiwan University Hospital between June 1987 and March 2012 were enrolled. In the same period, 226 dilated cardiomyopathy (DCM) patients were enrolled as the control group. The RHD group experienced more right ventricular failure and higher central venous pressure than the control group, which resulted in impaired liver and kidney function. The RHD patients had a lower 15-year survival rate than the DCM patients after transplantation (22.7% vs. 45.7%, P=0.038) and higher incidence of tricuspid regurgitation than the control group (32.2% vs. 11.4%). No differences existed between the groups for the mitral regurgitation rate (RHD 37.7% vs. DCM 29.4%, P=0.562).
  
  
  CONCLUSIONS
  Preoperatively, the RHD patients suffered more tricuspid regurgitation than the control group. The aortic and mitral valves in both groups functioned well over the long term. Heart transplantation for endstage RHD had a long-term survival rate that was inferior to that for DCM patients.
authors: Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine.
authors: Nai-Hsin
authors: NH
authors: Chi
authors: Nai-Kuan
authors: NK
authors: Chou
authors: Ya-Hui
authors: YH
authors: Yu
authors: Hsi-Yu
authors: HY
authors: Yu
authors: I-Hui
authors: IH
authors: Wu
authors: Yih-Sharng
authors: YS
authors: Chen
authors: Shu-Chien
authors: SC
authors: Huang
authors: Wen-Je
authors: WJ
authors: Ko
authors: Shoei-Shen
authors: SS
authors: Wang
mesh_terms: D000328:Adult; D018572:Disease-Free Survival; D019353:Endemic Diseases; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000401:mortality / Q000601:surgery; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D018497:Ventricular Dysfunction, Right / Q000209:etiology* / Q000401:mortality*