Department of Cardiothoracic Science, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.
J Cardiovasc Med (Hagerstown). 2019 Apr;20(4):264-266. doi: 10.2459/JCM.0000000000000772.
: Heart transplantation is a life-saving therapy for some patients admitted for acute myocarditis. However, controversial exists about the major risk of rejection following heart transplantation in specific types of myocarditis. Because of relatively few data on the post heart transplant outcomes, we report the long-term follow-up of a 39-year-old patient with a previous history of ulcerative colitis, which rapidly worsened heart failure until an emergency heart transplant in 2004.The clinical course was complicated by many episodes of rejection; lastly, after the development of severe cardiac allograft vasculopathy, re-heart transplantation was needed. The main findings of this case are: 1) inflammatory aetiology should always be suspected in patients with concomitant autoimmune disease that developing rapidly progressing heart failure; 2) patients with inflammatory myocardial disease undergoing heart transplantation should also undergo strict immunological surveillance; 3) the option of performing the re-heart transplant in a patient with a so complex management in the first one could be uncertain, but in this case the young age and lack of noncardiac comorbidities were effective to favour the survivor after two immunologically so challenging heart transplantation.
心脏移植是某些急性心肌炎患者的救命疗法。然而，对于特定类型心肌炎患者心脏移植后发生排斥反应的主要风险存在争议。由于心脏移植后结局的数据相对较少，我们报告了一位 39 岁溃疡性结肠炎既往史患者的长期随访情况，该患者的心力衰竭迅速恶化，直至 2004 年紧急进行心脏移植。该临床病程复杂，多次发生排斥反应；最后，在发生严重的心脏同种异体血管病变后，需要再次进行心脏移植。该病例的主要发现包括：1）伴有自身免疫性疾病且迅速进展性心力衰竭的患者，应始终怀疑炎症病因；2）接受心脏移植的炎症性心肌疾病患者也应进行严格的免疫监测；3）对于在首次心脏移植中存在如此复杂管理的患者，再次进行心脏移植的选择可能并不确定，但在这种情况下，年轻和无非心脏合并症的情况有利于在两次免疫挑战性心脏移植后存活。
