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Stress Echocardiography After Cardiac Transplantation

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Stress Echocardiography

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Abstract

Cardiac transplantation is an increasingly important treatment for end-stage cardiac disease, but rejection continues to be a major complication [1]. Rejection can be either acute or chronic (Table 35.1). Acute rejection is a major problem in the first year following cardiac transplantation. It is characterized by subtle or overt myocardial dysfunction, with normal epicardial coronary arteries. However, the coronary flow reserve, a pathophysiological hallmark of microvascular disease (as has been described in other situations such as syndrome X or hypertension with normal coronary arteries [2, 3]), may be impaired, particularly in severe rejections [4, 5]. In particular, during acute cardiac rejection, the reversible reduction of coronary reserve could be the result of the limitation of vasodilatation due to functional abnormalities such as metabolically or immunologically related decreased responsiveness of the vascular wall to vasodilator stimuli or to structural abnormalities, such as interstitial edema or cellular infiltration [4]. Immunosuppressive treatment can resolve structural and functional abnormalities and restore the normal coronary flow reserve [4].

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Authors and Affiliations

  1. Echocardiography Lab, Cardiology Department, Università Cattolica, Rome, Italy

    Leyla Elif Sade

  2. CNR Pisa, Ist. Fisiologia Clinica, Via Moruzzi 1, Pisa, 56124, Italy

    Eugenio Picano

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  1. Leyla Elif Sade
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  2. Eugenio Picano
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Correspondence to Leyla Elif Sade .

Table of Contents Video Companion

Table of Contents Video Companion

  • See illustrative case numbers 36, 37, and 38 by Prof Sade, MD, Ankara, Turkey, and case numbers 39 and 40 by Tonino Bombardini, MD, PhD, Pisa, Italy.

  • See also, in the section Nuovo Cinema Paradiso remastered, the short movie: “A novel silver heart from National Research Council,” by Tonino Bombardini, MD, PhD, Pisa, Italy.

  • Springer Extra Materials available at http://extras.springer.com/2015/978-3-319-20957-9

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Sade, L.E., Picano, E. (2015). Stress Echocardiography After Cardiac Transplantation. In: Stress Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-319-20958-6_35

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  • DOI: https://doi.org/10.1007/978-3-319-20958-6_35

  • Publisher Name: Springer, Cham

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