Cardiac transplantation (TxC) is considered the first therapeutic option in patients with congestive heart failure, refractory to clinical treatment and without the possibility of conventional surgical treatment. The pathophysiological status, as a consequence of severe cardiomyopathy, is represented by various degrees of systolic and diastolic dysfunction, reflecting low ejection volumes and high diastolic volumes and high filling diastolic pressures, respectively. Patients in this pathophysiological context also present, among other symptoms, neurohormonal alterations of the renin-angiotensin aldosterone system, decreased renal, visceral and splanchnic perfusion, and increased levels of catecholamines. Barnard et al., in 1967, performed the first orthotopic heart transplantation among humans with relative success, Zerbini (1969) being the first to perform it in Brazil. The presence of high rates of graft rejection and infection accounted for small survival and caused great disinterest and abandonment of the technique in the 70’s. However, the experience accumulated by the groups that maintained TxC as a treatment, mainly after the introduction of cyclosporin A, first in kidney transplantation in 1978, and in 1980 in TxC, reinvigorated this therapeutic option, allowing the true development and the application of this treatment worldwide.
Part of the book: Heart Transplantation
Our organism, as complex as it is, needs a giant vascular network to deliver nutrients to all cells, so vasculopathies and vasculitis are diseases present in all medical specialties. The skin and subcutaneous cellular tissue are irrigated by a vast vascular network, with cutaneous involvement related to these frequent pathologies. These can be restricted to the integumentary system or be part of systemic diseases with cutaneous manifestations, which make them of great interest to dermatologists. They can affect any caliber of vessels and present with several dermatological manifestations such as erythema, livedo reticularis, palpable purpura, nodules, ulcers, urticaria, hemorrhagic blisters, gangrene and other manifestations that can be isolated or associated with systemic signs and symptoms. However, there is no worldwide consensus regarding the classification of vasculitis, and the classification proposed in this chapter is based on the International Chapel Hill Conference Nomenclature of Vasculitides 2012, which is based on the size of the vessels. The purpose of this chapter is to compile a review of the most current treatments for these conditions.
Part of the book: Vascular Biology