title: Heart Transplant in Patients with Predominantly Rheumatic Valvular Heart Disease.
abstract: OBJECTIVE
  International records indicate that only 2.6% of patients with heart transplants have valvular heart disease. The study aim was to evaluate the epidemiological and clinical profile of patients with valvular heart disease undergoing heart transplantation.
  
  
  METHODS
  Between 1985 and 2013, a total of 569 heart transplants was performed at the authors' institution. Twenty patients (13 men, seven women; mean age 39.5 +/- 15.2 years) underwent heart transplant due to structural (primary) valvular disease. Analyses were made of the patients' clinical profile, laboratory data, echocardiographic and histopathological data, and mortality and rejection.
  
  
  RESULTS
  Of the patients, 18 (90%) had a rheumatic etiology, with 85% having undergone previous valve surgery (45% had one or more operations), and 95% with a normal functioning valve prosthesis at the time of transplantation. Atrial fibrillation was present in seven patients (35%), while nine (45%) were in NYHA functional class IV and eight (40%) in class III. The indication for cardiac transplantation was refractory heart failure in seven patients (35%) and persistent NYHA class III/IV in ten (50%). The mean left ventricular ejection fraction (LVEF) was 26.6 +/- 7.9%. The one-year mortality was 20%. Histological examination of the recipients' hearts showed five (27.7%) to have reactivated rheumatic myocarditis without prior diagnosis at the time of transplantation. Univariate analysis showed that age, gender, LVEF, rheumatic activity and rejection were not associated with mortality at one year.
  
  
  CONCLUSIONS
  Among the present patient cohort, rheumatic heart disease was the leading cause of heart transplantation, and a significant proportion of these patients had reactivated myocarditis diagnosed in the histological analyses. Thus, it appears valid to investigate the existence of rheumatic activity, especially in valvular cardiomyopathy with severe systolic dysfunction before transplantation.
authors.forename: Vitor E E
authors.initials: VE
authors.lastname: Rosa
authors.forename: Antonio S S A
authors.initials: AS
authors.lastname: Lopes
authors.forename: Tarso A D
authors.initials: TA
authors.lastname: Accorsi
authors.forename: Joao Ricardo C
authors.initials: JR
authors.lastname: Fernandes
authors.forename: Guilherme S
authors.initials: GS
authors.lastname: Spina
authors.forename: Roney O
authors.initials: RO
authors.lastname: Sampaio
authors.forename: Fernando
authors.initials: F
authors.lastname: Bacal
authors.forename: Flavio
authors.initials: F
authors.lastname: Tarasoutchi
mesh_terms: D000328:Adult; D001938:Brazil; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D006084:Graft Rejection / Q000401:mortality; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012307:Risk Factors; D013318:Stroke Volume; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D016277:Ventricular Function, Left; D055815:Young Adult