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Analysis of selected genetic markers in patients after heart transplant
Petříková, Nikola ; Hubáček, Jaroslav (advisor) ; Vrablík, Michal (referee)
Heart transplantation is performed in patients with end-stage heart failure, in whom all other methods of treatment failed. The most common causes of end-stage heart failure are dilated cardiomyopathy and coronary artery disease. The destiny of these patients is highly variable. Prediction of long term survival in patients after heart transplantation is not satisfactory and up to now has not been found reliable marker. Most of the patients die after heart transplantation due to cardiovascular disease. This thesis is focused on molecular genetics and statistical analysis of four single nucleotide polymorphisms, namely rs17817449 (16q12.2, FTO gene), rs2943634 (2q36.3; intergenic region), rs6922269 (6q25.1; MTHFD1L gene), and rs10757274 (9p21.3; intergenic region). According to genome wide association studies are these SNPs assosiated with cardiovascular diseases. We genotyped DNA samples of 364 heart donors and 364 heart recipients. The results were statistically compared (using OR and Pearson's χ2 test) with the control group, which consisted of samples of individuals from the general population MONICA study. We examined the genotype in patients whose hearts failed due to dilated cardiomyopathy or coronary artery disease and then in patients with cardiac allograft vasculopathy. Furthermore, we focused on...
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Problems of patients with long-term cardiac support
Ondráčková, Lucie ; Pavlíková, Pavla (advisor) ; Černá, Alena (referee)
Bachelor thesis is divided into theoretical and empirical part. The theoretical part is devoted to heart failure, given that it is patients with end stage heart failure is a long-term cardiac support implemented. It is described surgical treatment of heart failure and various cardiac support. A separate section is devoted to long-term cardiac support-Heart Mate II. Conclusion The theoretical part is devoted to the specifics of treatment of patients with established long-term cardiac support. The empirical part of the paper maps out the problems of patients with established long- term cardiac support. The method used to implement the survey questionnaire. The studied group consisted of 21 patients with established long-term cardiac support in outpatient care. Reconnaissance survey conducted in the outpatient department of heart failure IKEM in Prague. The work shows that although the introduction of cardiac support for patients and mentally demanding affects their daily life, most of them feel improvements in your health and well-established cardiac support perceived as a chance to wait for a heart transplant.
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Allooimmunosensitization in left ventricular assist device recipients and impact on post-transplantation outcome
Urban, Marián ; Netuka, Ivan (advisor) ; Ošťádal, Petr (referee) ; Mrázek, František (referee)
Background: In recent years mechanical circulatory assist devices became an established option in bridging patients with refractory heart failure to heart transplantation. One of the alleged limitations of mechanical devices is a high degree of antibody production with possible deleterious effect on subsequent heart transplantation outcome. Aim: The main goal of this study is to assess the role of antibodies on the outcome of surgical treatment of patients with end- stage heart failure. Method: Firstly, we present a literature review on the current state of knowledge of possible immunologic mechanisms involved in antibody production in left ventricular assist device (LVAD) recipients, new methods of antibody detection, desensitization strategies and overview of published evidence assessing the impact of sensitization on post-transplantation outcome. In the experimental part of our study we prospectively evaluated the presence of anti-Angiotensin II Type 1 Receptor (AT1R) antibodies in 83 Heart Mate II (HMII) recipients who were implanted at our institution between 2008 and 2012 and survived the first 60 days. On-device survival and device malfunction, major infection, major bleeding and neurologic dysfunction were compared between antibody positive and antibody negative recipients. Out of a total...
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Nursing care for pacients with heart transplantation.
VINKLEROVÁ, Petra
The bachelor thesis focuses on the issues of nursing care of patients with heart transplantation. The first heart transplantation in the Czech Republic was performed in IKEM, Prague in 1984. There are seven transplantation centres in the Czech Republic, but only those in Prague and Brno perform heart transplantation. The thesis is divided into a theoretical and a practical part, while the theoretical part also deals with the anatomy, history and characteristics of transplantation. Heart transplantation is performed on patients with heart disease at the stage of terminal heart collapse. A recipient has to meet some conditions for the transplantation. He/she has to be added to a register on the waiting list, must have the same blood group as the donor, similar weight and be less than fifty five years old. A suitable donor is necessary. Another condition is that all the conditions of Act No. 285/2002 Col. as amended have to be met. The fact that the donor is not in the national register of persons not agreeing with post mortem organs or tissues donation has to be excluded and his/her identification has to be confirmed. Before a patient is added to the waiting list he/she undergoes detailed examination to determine the urgency of addition to the waiting list. As transplantation is considered an acute surgical intervention the recipient only undergoes an immediate body preparation before the operation when a suitable donor is found. The theoretical part then describes heart removal from the donor, the operation procedure and heart transplantation techniques. There are three heart removal techniques nowadays. The biggest attention is paid to postoperative care. It includes endomyocardial biopsy, which is done in regular intervals, control visits and administration of immunosuppressive drugs. Post transplantation complications that might occur in early or later postoperative period are also dealt with there. Postoperative care also includes education in postoperative regimen. The main goal of the thesis was to map the specifics of nursing care of patients after heart transplantation both before and after operation. A partial goal was to find out in what way patients are given information on postoperative regimen after heart transplantation. The thesis also endeavours to determine the difference between nursing care provided to patients after heart transplantation and after cardiac surgical operation. The empiric part of the thesis involved qualitative research, for which research questions had been set. The research sample consisted of seven nurses. Four nurses were from the Institute for Clinical and Experimental Medicine in Prague and three from cardiac surgery department of the České Budějovice Hospital. The research had the form of non-standardized interview at a nurse daily room and one in domestic environment. The results are based on the interviews and were processed by means of categorized groups. The results show that nursing care of patients after heart transplantation does not differ from that of patients after cardiac surgery operation. There are differences between examinations of patients before heart transplantation. We may see them in the most important preoperative examinations. They include special taking of antibodies as they define the intensity of administered immunosuppressive medication. The difference in postoperative care is in regular medical checkups. There are big differences in social contacts between patients and their environment. Provision of detailed information to the patient is an important part of the nursing care. Information should be provided during both preoperative and postoperative care. The other spheres are identical. The thesis should be beneficial for nurses caring of patients after heart transplantation, but also for those who are deciding whether to undertake heart transplantation or are more closely interested in the problems of heart transplantation.
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