Heart transplantation pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
The pathogenesis leading to a cardiac transplant involves the mechanisms leading up to heart failure. The pathophysiology of [disease/malignancy] depends on the histological subtype.
Pathophysiology
Pathogenesis
Cardiac Transplantation is the treatment for patients with intractable heart failure, not amenable to medical and device therapy.
- Heart failure is a complex syndrome whereby there is an inadequate output of the heart to meet the metabolic demands of the body. Heart failure is caused by abnormal function of different parts of the heart including the pericardium, the myocardium, the endocardium, the heart valves and the great vessels.
- Heart failure is characterized by decreased cardiac output but not necessarily decreased ejection fraction.
- Symptoms of heart failure are due to a lack of both forward blood flow to the body, and backward flow into the lungs. The body tries to compensate for the low cardiac output by mechanisms that increase the preload and afterload. These mechanisms lead to exacerbation of the cardiac malfunction and symptoms associated with heart failure.
It is understood that heart failure is the end result of many causes- Common causes and indications that result in the need for cardiac transplantation may include:[1]
- Systolic Heart Failure with a Left Ventricular Ejection Fraction less than 35%
- Ischemic cardiomyopathy
- Dilated cardiomyopathy
- Valvular heart disease
- Hypertensive heart disease
- Etiologies which are excluded are amyloid, HIV, and cardiac sarcoma
- Ischemic Coronary Artery Disease with Refractory Angina
- Intractable life-threatening Arrhythmias
- Ventricular arrhythmias which are not controlled by an implantable cardioverter-defibrillator
- Cardiomyopathies
- Restrictive and Hypertrophic Cardiomyopathies with NYHA Class IV heart failure symptoms
- Non-dilated cardiomyopathies
- Congenital Heart Disease
- New York Heart Association functional class IV Heart Failure not amenable to surgery.
Gross Pathology
Pre-transplantation
On gross pathology, biventricular hypertrophy, moderate to severe all-chamber dilatation are characteristic findings.
Microscopic Pathology
On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
References
- ↑ Mehra MR, Canter CE, Hannan MM, Semigran MJ, Uber PA, Baran DA; et al. (2016). "The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update". J Heart Lung Transplant. 35 (1): 1–23. doi:10.1016/j.healun.2015.10.023. PMID 26776864.