Class of 2015 Abstract / Objectives: Assess the impact of hydralazine in contributing to the risk of heart transplant rejection. Our primary working hypothesis is that patients who have undergone heart transplantation and have taken hydralazine have an increased risk of transplant rejection and ultimately have worse outcomes. Methods: A retrospective cohort study on data extracted from a patient’s medical chart at a local hospital. Data was collected using a paper data extraction form consisting of gender, race, age, panel reactive antibody scores, co-morbidities, white blood cell count, type of immunosuppression therapy and any other medications. The proportion of patients with rejections will then be compared and analyzed using a chi square test. Results: This study obtained 340 patient cases that involved heart transplantation. From the 340 patients that were extracted, 42 of them were recorded as having taken hydralazine. Of the 42 patients, 7 had stopped hydralazine before transplantation. The mean +/- S.D. age of the 35 patients analyzed was 54 +/- 20.5 years, and 69% were men. Approximately 14% of the 42 patients were found to have had a heart transplant rejection. Conclusions: Heart transplant patients at this institution who received hydralazine post surgery were on it about an average of 21 months. Most patients were placed on ACE inhibitors. ACE inhibitors have a theoretical benefit of immunosuppression, and this therapy is usually pursued in transplant patients. Further research must be done to determine the clinical significance of hydralazine use in heart transplant rejection.

Despite the establishment of heart transplantation as a life-saving therapy for children and adolescents, little research has focused on the biopsychosocial impact of the transplant process. Few studies have captured the subjective experiences of young heart transplant recipients. This program of research examined how pediatric heart transplant recipients construct their worlds and the meanings they ascribe to their transplant experience. A grounded theory approach was implemented which guided data collection and analysis. A total of twenty-seven adolescents participated in semi-structured qualitative interviews. Findings illuminate pediatric heart transplantation to be a pervasive experience, with consequent impact on physical, psychological and social well-being. Participants described various biopsychosocial processes and experiences that occurred over the course of their transplant journey. Data analysis yielded themes of quality of life reflecting notions of temporality including: 1) the pre-transplant experience – a struggle to survive, 2) the transplant surgery and hospitalization – a difficult transition and 3) the post-transplant experience – an awakening and transformation. This research identifies that heart transplantation, which may contain elements of suffering and loss, may ultimately enhance young recipients’ overall quality of life. Results reveal the possibility that adolescent heart transplant recipients not only adapt to transplantation, but also potentially experience associated growth-enhancing experiences. An emergent theoretical model is presented, with implications for practice and research.

Despite the establishment of heart transplantation as a life-saving therapy for children and adolescents, little research has focused on the biopsychosocial impact of the transplant process. Few studies have captured the subjective experiences of young heart transplant recipients. This program of research examined how pediatric heart transplant recipients construct their worlds and the meanings they ascribe to their transplant experience. A grounded theory approach was implemented which guided data collection and analysis. A total of twenty-seven adolescents participated in semi-structured qualitative interviews. Findings illuminate pediatric heart transplantation to be a pervasive experience, with consequent impact on physical, psychological and social well-being. Participants described various biopsychosocial processes and experiences that occurred over the course of their transplant journey. Data analysis yielded themes of quality of life reflecting notions of temporality including: 1) the pre-transplant experience – a struggle to survive, 2) the transplant surgery and hospitalization – a difficult transition and 3) the post-transplant experience – an awakening and transformation. This research identifies that heart transplantation, which may contain elements of suffering and loss, may ultimately enhance young recipients’ overall quality of life. Results reveal the possibility that adolescent heart transplant recipients not only adapt to transplantation, but also potentially experience associated growth-enhancing experiences. An emergent theoretical model is presented, with implications for practice and research.

Background: In Sweden the primary reason for heart transplants is severe heart failure. Heart transplants are performed both at Sahlgrenska University hospital and at Skånes University hospital. Patient undergoing several extensive investigations before he or she will be considered for the waiting list. Primary factor for receiving a heart is first of all the patient who is in the greatest need of a new heart and the patient most suited to receive the donated heart. Previous studies show that patients feel the waiting time to be unpredictable. Aim: To describe patients’ experiences of the time before a heart transplant. Method: Qualitative content analysis was used as the analysis method and seven blogs were applied. Results: Life is seen from a new and different perspective. A common factor for patients with heart failure was the physical limitation they felt. Life stopped for a while, and a waiting to regain “life” grew strong. Family and nursing staff was thought to play an important role. To maintain a positive attitude was thought to be a criterion to manage the anticipations. Conclusion: A patient waiting for a heart transplant experiences a change in their life world. To allow proper care it is important that the nurse recognizes this change and acknowledge it.

Improved success of paediatric cardiac transplantation has resulted in increased survival of recipients into young adulthood (19 to 29 years of age). Young adults who received a heart transplant during childhood have experienced multiple life sustaining procedures. As survival and longevity increase, it is clear that transplant recipients experience negative physiological, psychological and social sequelae. With heart transplant offering individuals a chance to extend life into young adulthood, recipients need lifelong care and at age 18 they will transition from paediatric to adult healthcare facilities. The study addressed young adults circumstances of existence and their competing interests within various social environments. This research project applied Pierre Bourdieu’s theoretical concepts of habitus, field and capital, to conceptualize and engage with empirical knowledge production about young adults who have received a heart transplant during childhood. Using visual methodology, focused open-ended interviews were conducted with 12 young adults who had a heart transplant during childhood. Bourdieu’s work provided a theoretical framework to investigate transplant recipients’ identities and social repositioning in relation to dominant discourses of organ transplant and shifting relationships with health services providers. This study involved an iterative process to identify recipients’ encounters and new compositions in relation with others, in order to answer the research objective. These findings highlight that young adult transplant recipients struggle with relational dispositions that excludes them from various fields of social engagement; their struggle and exclusion from various fields is symbolic and is embedded in the structure of the dominant social order of the field from where they become excluded; the social order is taken up and embodied, leading young transplant recipients to practices of accommodation and “normalization”. Changes in healthcare practices, attuned to person implications and peer relationships can begin to address young transplant recipients’ contradictory social positions. Such an approach can potentially lead to improvement in ongoing care and services for young adults who require a lifetime of care. At the same time, it will allow nurses to better prepare and counsel young individuals who are preparing for a heart transplant.

Improved success of paediatric cardiac transplantation has resulted in increased survival of recipients into young adulthood (19 to 29 years of age). Young adults who received a heart transplant during childhood have experienced multiple life sustaining procedures. As survival and longevity increase, it is clear that transplant recipients experience negative physiological, psychological and social sequelae. With heart transplant offering individuals a chance to extend life into young adulthood, recipients need lifelong care and at age 18 they will transition from paediatric to adult healthcare facilities. The study addressed young adults circumstances of existence and their competing interests within various social environments. This research project applied Pierre Bourdieu’s theoretical concepts of habitus, field and capital, to conceptualize and engage with empirical knowledge production about young adults who have received a heart transplant during childhood. Using visual methodology, focused open-ended interviews were conducted with 12 young adults who had a heart transplant during childhood. Bourdieu’s work provided a theoretical framework to investigate transplant recipients’ identities and social repositioning in relation to dominant discourses of organ transplant and shifting relationships with health services providers. This study involved an iterative process to identify recipients’ encounters and new compositions in relation with others, in order to answer the research objective. These findings highlight that young adult transplant recipients struggle with relational dispositions that excludes them from various fields of social engagement; their struggle and exclusion from various fields is symbolic and is embedded in the structure of the dominant social order of the field from where they become excluded; the social order is taken up and embodied, leading young transplant recipients to practices of accommodation and “normalization”. Changes in healthcare practices, attuned to person implications and peer relationships can begin to address young transplant recipients’ contradictory social positions. Such an approach can potentially lead to improvement in ongoing care and services for young adults who require a lifetime of care. At the same time, it will allow nurses to better prepare and counsel young individuals who are preparing for a heart transplant.

nÃo hà / O transplante cardÃaco à uma modalidade terapÃutica de alta complexidade e exige do enfermeiro uma assistÃncia especÃfica, com qualidade, tendo como foco o autocuidado, uma vez que possibilita o envolvimento do paciente de maneira participativa no tratamento. Teve-se como objetivo geral avaliar o autocuidado de pacientes que realizaram transplante cardÃaco, baseado no Modelo do Autocuidado de Orem. E como especÃficos: identificar os fatores condicionantes que interferem na prÃtica do autocuidado de paciente transplantado cardÃaco apÃs a alta hospitalar; verificar os dÃficits de autocuidado de pacientes adultos que realizaram transplante cardÃaco; e correlacionar os fatores condicionantes com o Perfil de Engajamento do Autocuidado. Trata-se de um estudo descritivo-analÃtico, com delineamento transversal e natureza quantitativa, desenvolvido na Unidade de Transplante e InsuficiÃncia CardÃaca de um hospital pÃblico terciÃrio da cidade de Fortaleza-CearÃ-Brasil. A amostra foi composta por 63 pacientes transplantados cardÃacos, que atenderam aos critÃrios de inclusÃo. A coleta de dados foi realizada mediante uma entrevista individualizada, no perÃodo de outubro a dezembro de 2011. O projeto foi aprovado pelo Comità de Ãtica e Pesquisa, sob protocolo do CEP/HM: 109/11. Como resultados dos fatores condicionantes, obteve-se: sexo masculino (88,9%); a idade variou de 23 a 72 anos, predominando de 40 a 59 anos (68,3%); cor da pele nÃo-branca (74,6%), catÃlico (81,0%); casado (77,8%); procedentes do interior do estado (49,2%); nÃvel de escolaridade-ensino fundamental (71,4%); aposentado ou nÃo trabalha (82,5%); renda de atà um salÃrio mÃnimo (47,6%); miocardiopatia chagÃsica (28,6%); tempo pÃs-transplante entre um e trÃs anos (39,7%). Em relaÃÃo ao autocuidado do requisito universal, tÃm-se como dÃficit os seguintes dados: oxigenaÃÃo/respiraÃÃo (26,9%); higiene pessoal (31,7%); higiene do ambiente domiciliar (47,6%); ingestÃo de lÃquidos (39,6%); ingestÃo de alimentos (68,8%); eliminaÃÃes (20,6%); prÃtica de exercÃcio fÃsico (87,3%); sono e repouso (79,3%); interaÃÃo social (90,4%); comportamento emocional (58,7%); prevenÃÃo de doenÃa/promoÃÃo da saÃde (77,7%); tabagismo (1,58%); etilismo (3,17%); prÃtica sexual (61,9%); prevenÃÃo do cÃncer (60,3%). Quanto ao autocuidado do requisito desenvolvimental, apresentou os seguintes dÃficits: participaÃÃo das atividades educativas (39,6%); adaptaÃÃo Ãs mudanÃas apÃs transplante cardÃaco (34,9%). E ao requisito desvio de saÃde, tÃm-se os seguintes dÃficits: comparecimento Ãs consultas da equipe de saÃde (41,2%); imunizaÃÃo bÃsica (100%); uso de mÃscara descartÃvel (46%); contato com pessoas e animais domÃsticos (38%); e conhecimento (20,6%). O Perfil de Engajamento do Autocuidado variou de 88 a 113, constatando-se que a maioria dos pacientes apresentou algum dÃficit de autocuidado, pois 57,1% estavam na classe que âfrequentemente realizava autocuidadoâ. No entanto, embora nenhum paciente realizasse 100% das prÃticas de autocuidado recomendadas para o transplantado cardÃaco, 42,9% sempre realizavam o autocuidado. Conclui-se que os pacientes transplantados cardÃacos apresentam dÃficit de autocuidado para manutenÃÃo e promoÃÃo da saÃde. Portanto, à necessÃrio que os profissionais da equipe de transplante cardÃaco estejam atentos para os fatores condicionantes do autocuidado dos pacientes transplantados cardÃacos, visando estabelecer estratÃgias para reduÃÃo do dÃficit de autocuidado.

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Background: Since constrictive pericarditis is most often idiopathic and the pathophysiology remains largely unknown, both the diagnosis and the treatment can be challenging. However, by definition, inflammatory processes are central to this disease process. Amniotic membrane patches have been shown to possess anti-inflammatory properties and are believed to be immune privileged. Due to these properties, amniotic membrane patches were applied intraoperatively in a complicated patient presenting with constrictive pericarditis. Case presentation: A patient with a history of multiple cardiac surgeries presented with marked fatigue, worsening dyspnea and sinus tachycardia. He was found to have constrictive physiology during cardiac catheterization, with cardiac MRI demonstrating hepatic vein dilatation, atrial enlargement and ventricular narrowing. After amniotic membrane patch treatment and pericardiectomy, post-operative cardiac MRI failed to demonstrate any appreciable pericardial effusion or inflammation, with no increased T2 signal that would suggest edema. Conclusions: Given the positive results seen in this complex patient, we suggest continued research into the beneficial properties of amniotic membrane patches in cardiac surgery.