Guide for Heart Transplant Patients

Guide for Heart Transplant Patients

Heart transplantation has been a successful procedure performed on patients with heart failure all over the world, since the first operation performed in Capetown, South Africa, in December 1967. It has been accepted as a treatment.

STRUCTURE AND FUNCTION OF THE HEART

The heart is an organ composed of muscles about the size of a fist, located between the lungs, under the breastbone. The heart relaxes and contracts in a smooth and organized manner, pumping blood from the heart chambers to the body through large arteries. While blood carries oxygen and nutrients to the tissues, it removes harmful products and wastes from the body through the lungs, kidneys and liver.

CARDIOMYOPATHY

Cardiomyopathy is a condition that can cause heart failure. is a heart muscle disease. The heart muscle grows and loses its contractile functions, becomes unable to pump blood to organs and tissues effectively, and eventually heart failure develops. Excess water in the body begins to accumulate in the veins, lungs, liver, abdominal cavity and legs. Other organs that cannot receive enough oxygen and food are also damaged by this situation over time.

Causes of cardiomyopathy:

1. Dilated (expanded) cardiomyopathymay be due to the following causes:

• Viral (infection)
• Perpartum (postpartum period )
• Alcohol (develops in chronic alcoholics)
• Drug use
• Unknown cause

2.Ischemic cardiomyopathy

Insufficient blood supply to the heart muscle or heart attack(infarction) due to coronary artery disease It is the loss of muscle strength of the heart after birth.

3.Cardiomyopathy due to congenitalcauses: It is a type of cardiomyopathy seen in people with heart disease since birth.

4.Cardiomyopathies with hardened and thickened walls:

• Thickened (Hypertrophic)
• Unable to relax (Restrictive)

REQUIREMENT FOR HEART TRANSPLANTATION

Heart failure response to drug therapy Patients who do not respond or cannot be corrected by a surgical method are considered as heart transplant candidates.

PRE-TRANSPLANTATION ASSESSMENT PROCESS

The pre-transplant evaluation process requires the patient to apply to the transplantation department of the Cardiovascular Surgery Clinic. It starts with . The time spent in the hospital to perform the necessary examinations and prepare the patient as a suitable recipient candidate.

Heart transplant team

Heart transplant coordinator:Ensures communication between the patient, family and other transplantation team throughout the transplantation process.

Infectious diseases specialist:He is the specialist responsible for protecting patients against possible infections and treating diseases that have occurred.

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Pathology Specialist:Evaluates biopsies to understand tissue rejection. The biopsy result guides the doctor regarding the treatment to be given.

Heart transplantation surgeon:Surgically evaluates the feasibility of heart transplantation surgery. Performs surgery and post-operative follow-up.

 

Heart transplant cardiologist:Heart and other diseases (such as diabetes) if any. evaluates and gives pre- and post-transplant checks and necessary treatments.

Nurse:Works with the transplantation team and provides treatment and patient care.

Physiotherapist:Gives necessary exercises for the lungs and muscles.

Dietitian:Determines the ideal weight and gives information about dietary restrictions in heart failure.

Pre-transplant examinations

Electrocardiography (ECG)

An ECG is taken to check whether there are any additional problems with the heart.

Echocardiography (ECHO)

This test is performed to determine the pump function of the heart, the movements of the heart wall, the functioning of the valves and the dimensions of the heart chambers.

Lung X-ray

It is necessary for the size of the heart and possible lung problems.

Laboratory tests

Heart blood group and tissue type determination in the vascular surgery clinic, infectious diseases such as hepatitis and HIV ion parameters are checked, research is done on anemia, bleeding problems, kidney and liver diseases.

Catheterization and Angiography (Angiography)

It is entered from the groin through the artery and reaches the heart through an opaque artery. In this examination performed by administering a substance, blockages in the coronary arteries can be shown, the pressures of the heart chambers can be measured and the functions of the heart can be determined.

Peripheral Doppler test

Ultrasound of the groin, legs and feet. Stenosis and blockages in the vessels are examined.

Carotid Doppler test

It is an ultrasound examination of the carotid (carotid) vessels in the neck. By detecting obstructions and stenosis in advance, the risk of paralysis and stroke after surgery is reduced.

Abdominal ultrasound

With this study, all organs in the abdomen, liver, kidneys, pancreas, Ultrasound of the gallbladder and spleen is performed to investigate whether there is any disease.

Lung function tests

It measures the function and ventilation capacity of the lungs.

Vaccination

Flu, pneumonia and hepatitis (jaundice)vaccinations are given. Whether tuberculosis (TB) is present or not is investigated with a skin test.

Selection of the heart transplant patient

Whether a heart transplant is suitable for the patient is determined by a joint decision by taking the opinions and suggestions of each heart transplant team.

The criteria used as a basis for deciding on a heart transplant operation for a candidate are as follows:

ü Patients with end-stage heart failure that does not respond to drug treatment and who have no other medical or surgical treatment options are included in the transplantation program as heart transplant candidates.

Heart failure conditions that are not suitable for heart transplantation are as follows:

• Pulmonary hypertension
• Cancer
• Irrecoverable liver, heart or lung dysfunction.
• Active infection
• Ages over 65-70
• Diabetes that has caused vascular (vessel) damage (diabetes disease)
• Advanced cerebrovascular disease
• Excessive obesity or underweight
• Substance addiction
• Heart transplantation surgery cannot be performed in cases where brain and body function impairment is too severe to use the medications to be given

Donors (organ donors)

Heart After being placed on the transplant waiting list, the waiting process for the donor heart begins. When a donor is found according to their blood type (A, B, AB or O group) and body size, the recipient patients are invited to the hospital. One of the patients who is suitable is selected as the recipient. The doctors on duty will also consider many other criteria when making the selection. These may be problems such as the presence of active infection or pulmonary hypertension, which may require drug treatment during transplantation or put the surgery at risk.

No personal information about the donor will be given to the recipient. The information to be given is given by the transplantation coordinator. It will be as long as he deems appropriate.

Waiting process

The waiting process for a suitable donor can be long and emotionally and physically distressing. The patient will be given this process. Depending on the medication, the patient may spend it at home or in the hospital.

If the recipient patient is waiting at home, he/she must be prepared in advance so that he/she can leave the house without wasting time and reach the hospital quickly when called. Below is a list of items that should be kept ready.

• A ready-made bag containing personal belongings, pajamas, towels, glasses and underwear.
• Social security documents (Pension fund, Bağ-Kur report card).
• List of medications used.
• Telephone numbers of your home and relatives.

TRANSPLANTATION SURGERY

Once a donor heart is found, the transplant coordinator becomes a bridge between the donor evaluation team and the heart transplant team. Preparation and timing for transplant surgery are decided between the transplant team and the donor team. Since other organs will also be used, surgery will begin when conditions are suitable.

During heart transplant surgery, a large part of the heart will be removed. The surgeon will leave only a small piece of the base (atrium) inside so that he can sew the new heart onto it. The surgery will take approximately 4-5 hours.

Tra During and after the implantation surgery, the transplant coordinator informs the family about the patient's condition.

Post-operative care

Intensive Care Unit:Patient After surgery, he is taken to the intensive care unit. During this period, during which it will be closely monitored by doctors and nurses trained in this field, there are rules that the patient and the visiting relatives should know:

a. Everyone who enters the room must wash their hands. To protect the patient from germs, visitors are asked to wear protective clothing such as sterile shirts, gloves and masks.

b. In the first hours of the intensive care unit, the patient is connected to a breathing machine until the anesthetic substances lose their effect and the patient begins to breathe on his own.

c. Vascular lines will be attached to the patient's arm and neck so that he can receive the fluids and medications he needs and also to take samples for blood tests when necessary.

d. A urinary catheter is inserted to monitor urine output and the functioning of the kidneys. This catheter will be removed within 1-2 days after the surgery.

e. The tubes placed on the chest wall are inserted to remove the fluids accumulated inside and will be removed by the doctor in a short time. p>

f. Two thin wires located under the chest incision are placed to connect the pacemaker if needed and will be removed before discharge.

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h. strong>In intensive care, an attempt is made to strengthen the lungs by having the patient cough at regular intervals and exercising with a respiratory exercise device.

Post-operative exercise

The patient sits in the intensive care unit after leaving the breathing machine. and he is asked to walk. By increasing his daily activities a little more each day, he will be able to do his own work without help within a few days.

COMLICATIONS (PROBLEMS THAT MAY ARISE)

After transplantation. Some unexpected problems may be encountered.

The transplantation team will take the necessary precautions to prevent these problems from occurring in advance. The patient should pay attention to the warnings and respond to problems early.

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