THIS MONTH'S FOCUS:
HEART FAILURE & TRANSPLANTATION
Many thanks to Janet Scheel and David Nelson for coordinating the content for this month's issue.
VINCENT'S HALLOWEEN SENSE:
In this 4th Halloween issue since I have been Editor-in-Chief of the ISHLT Links newsletter we have moved frighteningly and cautiously from not only the road to Prague to Montreal to San Diego and to Nice but also from Halloween Sticky Links (last page) of cats, reapers and psychos to Vincent's Frightful and Phobophobic Sense and now Vincent's Halloween Sense. We have come a full circle as we regularly meet annually like a coven starting with Hector Berlioz's "Symphonie Fantastique - Dream of a Witches Sabbath" to the Hotel Berlioz situated in the famous musician's quarter in Nice named after Hector.
In this month's issue, the In The Spotlight article by Megan Barrett is on Monuments and Churches in Nice. Next we have Cardiac Recovery: The Best of Times, the Worst of Times by Scott Auerbach and Melanie Everitt along with Pediatric Heart Failure: It's Finally Growing Up by Heather Henderson, followed by Differential Response to Medications between Children and Adults with Heart Failure by Shelley Miyamoto, Brian Stauffer, and Carmen Sucharov. Wrapping up, not unlike a mummy for Halloween, the Pediatric section of this issue is Simon Urschel's fictitious science on The Science and Fiction of ABO Incompatible Transplantation.
The door then creaks open from the Heart Failure Council's overview on Recognizing an Unmet Need: The Role of a Patient and Family Advisory Council in Heart Transplant Care by Leslie Denend, Helen Luikart, and Jen Judas. Then, it's Jon Kobashigawa with US Heart Allocation Policy: Current Issues and Possibilities for Fix. Further, we have Grant Paulsen with a special piece, Enterovirus D68 is Making the Rounds. Finally, as yours truly needs a break and all of you receive a break from Voltaire while I prepare my costume for Halloween, let's give a warm ISHLT Links welcome to Patrick Yu, a fourth year Medical Student from UTMB in Galveston, Texas. He is a Phi Beta Kappa graduate from Texas Tech with a BS in Biochemistry and a Master's in Molecular Pathology. He brilliantly conceived and wrote an article for the Editor's Corner with yours truly. A frighteningly and eerily thoughtful link has been made across charged particles and synapses for all of us to ponder about the circuitous paths of the RC time constants and connections in Smartphones, Traffic Lights, and the Mechanical Ventilator.
Nice has revered Berlioz because he had spent time there. While there in 1844, he composed the overture La tour de Nice (The Tower of Nice) which was later renamed Le Corsaire. Berlioz later described the Tower of Nice "where I spent so many hours, from the top of which I sent so often my morning greetings to the slumbering sea before the sun would rise, you are trembling with joy on your rocky foundations, you feel happy to be a French tower!"
Vincent Valentine, MD
IN THE SPOTLIGHT:
ISHLT's Guide to Nice, France
With our Annual Meeting hplanned in a location as beautiful as Nice, we know there is much to consider outside the walls of The Acropolis. With this in mind, we have compiled a tourist's guide to all the top attractions in Nice that we will break down to share in each new issue of the Links Newsletter. This month's focus will be on Monuments and Churches. Though both are abundant among the rich culture and history of Nice, we have chosen to highlight a few more notable examples. Read more →
Cardiac Recovery: The Best of Times, the Worst of Times
Scott Auerbach and Melanie Everitt
A Tale of Two Cities comes to mind when I think of 2 recent patients and their potential for cardiac recovery. Both teenagers presented acutely with dilated cardiomyopathy and decompensated heart failure. Both patients were scheduled for elective VAD implant due to progressive deterioration on intravenous inotrope support. "Ana" received an acceptable donor organ 24 hours prior to the scheduled VAD implant. Ana's graft functioned well initially. "Jonathon" deteriorated precipitously prior to the elective VAD and suffered neurologic injury while undergoing VAD implant emergently. Read more →
Pediatric Heart Failure: It's Finally Growing Up
There is a well-known saying in pediatrics ... children are not small adults. Yet, in pediatric heart failure, the majority of our therapeutic strategies, both medical and mechanical, are based on adult data, and progress within our field is somewhat stagnant when compared to adult therapies. This is due to the limited and sometimes conflicting published data on small numbers of pediatric heart failure patients. But in children the diversity in the underlying causes of heart failure, both from congenital and acquired heart disease make it difficult to extrapolate from adult trials. Overall, there has been lack of multi-center collaboration and data collection. In the November 2012 issue of Links, Dr Yuk Law wrote about these same challenges. He described how the growth within our field led to the development of the Pediatric Heart Failure Workforce, a subcommittee within the Pediatric Council of the ISHLT. Over the past few years, the pediatric heart failure and transplant community has continued to grow and become more focused on developing research and therapies dedicated to heart failure in infants and children of all ages. Read more →
Differential Response to Medications between Children and Adults with Heart Failure
Shelley Miyamoto, Brian Stauffer, and Carmen Sucharov
Although the pathophysiology and treatment of adult heart failure (HF) is well studied, HF in children remains poorly understood with most clinical treatment paradigms based solely on experience in adults. Emerging experimental evidence and epidemiologic data confirm that the pediatric HF population distinctly differs from adult HF patients. The heterogeneous nature of pediatric HF and the lack of associated co-morbidities in children (eg diabetes, hypertension) prevent direct extrapolation of adult-based therapies. The most common cause of end-stage HF and indication for heart transplantation in infants is congenital heart disease, while dilated cardiomyopathy is the most common indication for transplant in children over the age of 1 year. The combination of age, heart failure etiology and differences in medication pharmacokinetics and metabolism in children complicates the ability to identify the most efficacious therapies . In addition, while adult HF survival has improved with the advancement of medical and surgical HF therapies, the outcome for children with HF has remained largely unchanged, which also suggests dissimilar pathophysiology. Read more →
The Science and Fiction of ABO Incompatible Transplantation
History: The ABO blood group system, which was first described by Nobel Laureate Karl Landsteiner in 1901, is based on polysaccharide antigens expressed on red blood cells. These antigens are also expressed on a variety of other cells including vascular endothelium. Consequently following some disastrous early experiences it was recognized that transplantation of solid organs across ABO blood group incompatibility mostly led to hyperacute rejection and loss of the organ, and, in the case of heart transplantation, associated loss of the patient. Adults and older children are regularly found to have preformed antibodies against their non-self blood group, predominantly but not exclusively of IgM type. The lack of expressed A or B antigens makes blood group O persons universal donors while the presence of both antigens in AB humans and consequent absence of antibodies to either blood group make them universal recipients. Read more →
HEART FAILURE AND TRANSPLANTATION:
Recognizing an Unmet Need: The Role of a Patient and Family Advisory Council in Heart Transplant Care
Leslie Denend, Helen Luikart, and Jen Judas
With the arrival of new hospital leadership at Stanford Health Care in 2011, the movement to patient and family centered care received a new sense of urgency. This change matched well with discussions that were well underway within the heart transplant program. The Heart Transplant Quality Council, a multi-disciplinary group representing all areas of the heart transplant program and hospital units of care, felt that the active involvement of patients and family members in their care could significantly aid in achieving target quality metrics, such as length of hospital stay and readmission rates, which were just then being formulated. A key element would be a Patient and Family Advisory Council. Read more →
US Heart Allocation Policy: Current Issues and Possibilities for Fix
US heart allocation policy has evolved considerably since the inception of the National Organ Transplant Act in 1984. An urgency-based system with concentric geographic zones was first adopted in 1988, with 2 priority statuses: Status 1, for all mechanical circulatory support (MCS) patients and those with inotropic dependency, and Status 2 for everyone else. Further modifications occurred in 1998 saw the introduction of a 3-tiered system, with Status 1A, the most urgent, intended for patients supported with MCS, mechanical ventilation, inotropic dependency with continuous hemodynamic monitoring, Status 1B for stable patients on ventricular assist devices (VADs) or inotrope infusions, and Status 2 for all others. Read more →
OF SPECIAL INTEREST: Infectious Diseases
Enterovirus D68 is Making the Rounds
The late summer cold season has been dominated by dramatic coverage of Enterovirus species D 68 (EV-D68) by most major media outlets. Many showed footage of busy Emergency Rooms and small children receiving breathing treatments. Initially reported as the 'Mystery Respiratory Virus' by some, it was subsequently determined that a strain of enterovirus was largely responsible. Enteroviral infections are common, often asymptomatic, and typically occur in the summer and fall. When symptoms do occur, they vary widely and in immune competent hosts may include mild upper respiratory infection, fever with rash, and neurologic illness, such as aseptic meningitis and encephalitis. Read more →
ISHLT NEWS AND ANNOUNCEMENTS:
ISHLT International Traveling Scholarships Awarded for August 2014
Andrew Fisher and Daniel R. Goldstein
The ISHLT community extends to every corner of the globe and our members offer world leading expertise in every aspect of heart and lung transplantation, mechanical circulatory support, pulmonary hypertension and management of the failing heart or lungs. We encourage you to take advantage of being part of this amazing community by applying for an ISHLT International Traveling Scholarship. On behalf of the ISHLT, we would like to congratulate the following August 2014 International Traveling Scholarship Recipients. Read more →
ISHLT Abstract Submission Deadline: November 3, 2014
The abstract submission deadine is just a month away! Submit your best science TODAY and plan to attend the ISHLT 35th Annual Meeting and Scientific Sessions in Nice, France, April 15-18, 2015. The deadline for abstract submissions is 11:59 PM EST on November 3, 2014. For more information, visit www.ishlt.org/meetings/abstracts.asp
Smartphones, Traffic Lights, and the Mechanical Ventilator: A Circuitous Path
by Patrick Yu and Vincent Valentine
Moore's law is an observation that technological power doubles with every year. The boom in technological advances has also affected our daily lives. The hallmark of the creative '60s was "tuned in, turned on and dropped out." Today we are simply "plugged in" from the start of our day to the finish, even "wirelessly." Try explaining that to ourselves in the 1960s. Today, we wake up to check our e-mail. We commute to work while listening to our pre-set radio stations. Even stopped at a traffic light, we reach for our smart phones to check for updates. Some of us are literally embedded with technology, ranging from pacemakers to being intubated on a mechanical ventilator in the ICU. There is no denying how linked we are to technology and each other. Read more →
JUST FOR FUN:
Witches hats, coal black cats, broomstick riders, bats and rats. Costumes queer, shrieks of fear, Strangest night in all the year. Did you know, Americans are expected to spend 8 BILLION DOLLARS on Halloween this year, with $2 billion on candy alone, making Halloween the second highest grossing commercial holiday after Christmas. But wait, there's more! Did you know, Americans are expected to spend $370 million just on Halloween costumes for their pets. Check out this cute collage for proof! Also there are Jack-o-Lanterns to light the scene. According to Irish legend, Jack O'Lanterns are named after a stingy man named Jack who, because he tricked the devil several times, was forbidden entrance into both heaven and hell. He was condemned to wander the Earth, waving his lantern to lead people away from their paths. Also interesting, as of October 19, 2013, Keene, New Hampshire, holds the record for the most Jack O'Lanterns lit at once (30,581), breaking Boston, Massachusetts' record of 30,128.
"I don't know that there are real ghosts and goblins, but there are always more trick-or-treaters than neighborhood kids."
— Robert Brault
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Disclaimer: Any opinion, conclusion or recommendation published by the Links is the sole expression of the writer(s) and does not necessarily reflect the views of the ISHLT.