Destination-Therapy Ventricular Assist Device in Children: “The Future Is Now”

This article reviews current trends in the use of DT VAD and adverse events in children vs adults on VAD, and provides a framework for patient selection with the use of a multidisciplinary approach including palliative care. The general approach to determining DT VAD candidacy should include: 1) a reasonable success that the patient will survive the peri- and postoperative state; and 2) a high likelihood that the patient will be able to be discharged out of hospital and have adequate caregiver support. Patients with muscular dystrophy and failing Fontan physiology are examples of pediatric populations for whom DT VAD may be considered and which require unique considerations.RésuméLes dispositifs d’assistance ventriculaire (DAV) durables ont significativement amélioré la survie après une transplantation chez les enfants présentant une insuffisance cardiaque avancée. Les objectifs premiers de l’implantation d’un DAV sont de réduire la mortalité, d’atténuer les événements indésirables et d’améliorer la qualité de vie. Au fil de l’évolution des connaissances en matière d’implantation de DAV chez les enfants, les complications liées au dispositif ont diminué et la survie s’est améliorée, ce qui fait que le traitement par DAV est aujourd’hui considéré non seulement comme...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research

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We report a case of a 30-year-old man who presented with advanced heart failure secondary to dilated cardiomyopathy. The patient was diagnosed with limb girdle muscular dystrophy type 2B (LGMD2B), a rare autosomal recessive disease. Cardiomyopathy is only rarely described in dysferlinopathies.
Source: Journal of Cardiac Failure - Category: Cardiology Authors: Tags: 295 Source Type: research
Duchenne/Becker muscular dystrophy (DMD/BMD) is a progressive skeletal myopathy as well as a cardiomyopathy. Historically, it is reported that patients with DMD/BMD experience significant morbidity/mortality as a result of rhythm abnormalities. However, natural history data is limited regarding the specific mode of death, e.g. heart failure vs. sudden cardiac death vs. non-cardiac death. We identified 82 patients at our institution to analyze retrospectively (67 DMD/15 BMD). Average age was 21 (range 10-38) years.
Source: Neuromuscular Disorders - Category: Neurology Authors: Source Type: research
Authors: Lamendola P, Lanza GA, Melita V, Villano A, Palermo C, Leone D, Lombardo A, Pennestrì F, Crea F, Mercuri EM, Pane M Abstract OBJECTIVE: Duchenne muscular dystrophy (DMD) is an inherited X-linked recessive neuromuscular disease caused by mutations of the dystrophin gene, leading to early and progressive muscle deterioration and dilated cardiomyopathy. The aim of this investigation was to assess whether treatment with sacubitril/valsartan (S/V) is well tolerated and may have beneficial effects in DMD patients with left ventricle (LV) dysfunction. PATIENTS AND METHODS: We administered S/V to 3 DMD ...
Source: European Review for Medical and Pharmacological Sciences - Category: Drugs & Pharmacology Tags: Eur Rev Med Pharmacol Sci Source Type: research
ConclusionsFinerenone administered as a monotherapy is disease modifying for both skeletal muscle and heart in a preclinical DMD model. These findings support further evaluation of finerenone in DMD clinical trials.
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Original Research Article Source Type: research
Duchenne muscular dystrophy (DMD; MIM No.310200) is the most common inherited muscle disease, estimated to affect approximately 1 out of 3,500 to 5,000 male newborns.1,2 It is a fatal disease diagnosed in childhood and characterized by progressive muscle wasting caused by a mutation in the DMD gene. Affected individuals commonly lose their ability to walk around 10 years after beginning to walk in infancy.3,4 Patients with DMD have multiple complications, of which cardiomyopathy and resultant heart failure is the most common cause of morbidity and mortality.
Source: Journal of Cardiac Failure - Category: Cardiology Authors: Tags: Research article Source Type: research
We describe the case of an 18‐year‐old male patient, affected by DMD and in a wheelchair from the age of 11. He progressively developed dilated cardiomyopathy, and in 2016, at the age of 14 years, he underwent HeartWare LVAD implantation, as destination therapy, without post‐operative complications. He has been followed up for 47 consecutive months; and 30 months after LVAD implantation, he developed an infection of the exit site, treated by antibiotics and surgical toilette. Following this event, on the basis of patient's good general conditions and willingness, we started to consider heart transplant as a...
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Case Report Source Type: research
Yokota Duchenne muscular dystrophy (DMD) is a fatal X-linked recessive condition caused primarily by out-of-frame mutations in the dystrophin gene. In males, DMD presents with progressive body-wide muscle deterioration, culminating in death as a result of cardiac or respiratory failure. A milder form of DMD exists, called Becker muscular dystrophy (BMD), which is typically caused by in-frame dystrophin gene mutations. It should be emphasized that DMD and BMD are not exclusive to males, as some female dystrophin mutation carriers do present with similar symptoms, generally at reduced levels of severity. Cardiac involve...
Source: Genes - Category: Genetics & Stem Cells Authors: Tags: Review Source Type: research
Duchenne muscular dystrophy (DMD) is a devastating and fatal disease affecting ~1 in 3500 boys with dystrophin gene mutations [1,2]. Dystrophin plays important roles in sarcolemma stability and cell signaling in skeletal, smooth, and cardiac muscles [1,2]. DMD patients often die at a young age from dilated cardiomyopathy (DCM) or respiratory dysfunction. The use of ventilators has reduced respiratory failure in DMD patients and DCM associated heart failure (HF) is now a major cause of DMD patient death [1,2].
Source: International Journal of Cardiology - Category: Cardiology Authors: Source Type: research
This article reviews the diagnosis and treatment of heart disease in Duchenne muscular dystrophy as well as emerging therapies.
Source: Current Heart Failure Reports - Category: Cardiology Source Type: research
Alterations in intracellular Na+ and Ca2+ have been observed in patients with Duchenne muscular dystrophy (DMD) and in animal models of DMD, and inhibition of Na+-H+ exchanger 1 (NHE1) by rimeporide has previously demonstrated cardioprotective effects in animal models of myocardial ischemia and heart failure. Since heart failure is becoming a predominant cause of death in DMD patients, this study aimed to demonstrate a cardioprotective effect of chronic administration of rimeporide in a canine model of DMD.
Source: International Journal of Cardiology - Category: Cardiology Authors: Source Type: research
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