The Journal of heart transplantation最新文献_第10页

Variations in the diagnosis, treatment, and prevention of cardiac allograft rejection: the need for standardization? 异体心脏移植排斥反应的诊断、治疗和预防:需要标准化吗?

The Journal of heart transplantation Pub Date : 1990-05-01

J B O'Connell, D G Renlund

引用次数: 0

Capillary and myofiber ultrastructure in endomyocardial biopsies from cyclosporine-treated heart transplant patients. 环孢素治疗心脏移植患者心肌内膜活检的毛细血管和肌纤维超微结构。

The Journal of heart transplantation Pub Date : 1990-05-01

R Yarom, D Admon, N Ron, M Mosseri, D Sapoznikov, M S Gotsman

{"title":"Capillary and myofiber ultrastructure in endomyocardial biopsies from cyclosporine-treated heart transplant patients.","authors":"R Yarom, D Admon, N Ron, M Mosseri, D Sapoznikov, M S Gotsman","doi":"","DOIUrl":"","url":null,"abstract":"This study focuses on the ultrastructure of microvessels and myofibers in 54 endomyocardial biopsy specimens from 16 patients treated with cyclosporine after heart transplantation. Although the capillary and myofiber pathologic condition was significantly correlated with the degree of rejection, ultrastructural changes sometimes occurred in biopsy specimens with little or no histologic cellular infiltration. Immunocytochemical studies of some biopsy specimens showed that all microvessels were positive for IgM, whereas concentrations of IgG, complement, and fibrin varied. The microvascular and myofiber changes appeared to be reversible and correlated (Pearson's coefficient of correlation of myofiber vacuoles and microangiopathy, R = 0.67, p less than 0.00001). The vacuoles in myofibers resembled those in subendocardial regions of ischemic myocardium. They could, however, be related to cyclosporine toxicity because similar vacuoles have been described in kidneys of transplant patients receiving cyclosporine. We conclude that in cases of unclear graft failure in the absence of classic signs of rejection, electron microscopy could be helpful in detecting microvascular and myofiber pathologic situations that may influence myocardial function.","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 3 Pt 1","pages":"187-96"},"PeriodicalIF":0.0,"publicationDate":"1990-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13504307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Use of polyclonal antilymphocytic preparations for prophylaxis in heart transplantation. 多克隆抗淋巴细胞制剂在心脏移植预防中的应用。

The Journal of heart transplantation Pub Date : 1990-05-01

J A Carey, W H Frist

引用次数: 0

Enhanced 24-hour in vitro heart preservation with adenosine and adenosine monophosphate. 腺苷和单磷酸腺苷增强24小时体外心脏保存。

The Journal of heart transplantation Pub Date : 1990-03-01

D Petsikas, M A Ricci, R Baffour, B de Varennes, J Symes, A Guerraty

{"title":"Enhanced 24-hour in vitro heart preservation with adenosine and adenosine monophosphate.","authors":"D Petsikas, M A Ricci, R Baffour, B de Varennes, J Symes, A Guerraty","doi":"","DOIUrl":"","url":null,"abstract":"Continuous hypothermic perfusion is an effective means of preserving ex vivo cardiac allografts. Using canine hearts, we assessed the ability of the high-energy phosphate precursors adenosine and adenosine monophosphate to enhance the protective effect of continuous hypothermic perfusion. Group 1 hearts (controls) were perfused for 24 hours with a modified Krebs-Henseleit solution. Group 2 hearts were perfused with control perfusate to which adenosine was added (20 mumol/L). Group 3 hearts were perfused with control perfusate with adenosine monophosphate (0.1 mmol/L). After perfusion heart weights increased similarly in all groups. Coronary vascular resistance increased during the preservation period in group 1 hearts, but decreased in groups 2 and 3 hearts. Developed pressures were 103 +/- 22 mm Hg in group 1, 163 +/- 27 mm Hg in group 2 (p less than 0.01), and 141 +/- 34 mm Hg (p less than 0.05) in group 3. The rate of pressure development in group 2 (2143 +/- 249 mm Hg) and group 3 (2059 +/- 395 mm Hg) hearts was significantly greater than in group 1 hearts (1434 +/- 363 mm Hg, p less than 0.01). Only group 3 myocardial adenosine triphosphate levels were significantly greater than controls (3.18 +/- 0.52 mumol/gm vs 2.12 +/- 0.74 mumol/gm, p less than 0.05) on completion of perfusion. Myocardial lactate levels at this time were significantly higher in group 1 hearts (7.48 +/- 3.96 mumol/gm) compared with groups 2 and 3 (0.34 +/- 0.58 mumol/gm and 1.50 +/- 0.91 mumol/gm, respectively, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 2","pages":"114-8"},"PeriodicalIF":0.0,"publicationDate":"1990-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13470139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Lack of progressive "restrictive" physiology after heart transplantation despite intervening episodes of allograft rejection: comparison of serial rest and exercise hemodynamics one and two years after transplantation. 尽管存在同种异体移植排斥反应，但心脏移植后缺乏进行性“限制性”生理:移植后1年和2年连续休息和运动血流动力学的比较

The Journal of heart transplantation Pub Date : 1990-03-01

J D Hosenpud, G A Pantely, M J Morton, R A Wilson, D J Norman, A M Cobanoglu, A Starr

{"title":"Lack of progressive \"restrictive\" physiology after heart transplantation despite intervening episodes of allograft rejection: comparison of serial rest and exercise hemodynamics one and two years after transplantation.","authors":"J D Hosenpud, G A Pantely, M J Morton, R A Wilson, D J Norman, A M Cobanoglu, A Starr","doi":"","DOIUrl":"","url":null,"abstract":"It has been suggested that the cardiac allograft becomes less compliant either because of repeated episodes of rejection, chronic hypertension, or as a direct consequence of immunosuppression. A corollary to this hypothesis is that this reduction in compliance should be a progressive, rather than a static, change. To test this hypothesis, rest and exercise filling pressures, cardiac outputs, and radionuclide ventriculographic systolic and diastolic indices were measured in 20 patients at 1 and 2 years after heart transplant by means of identical protocols at both study times. Between studies 10 of 20 patients had no rejection, five of 20 had one rejection episode, and five of 20 had more than one rejection episode. There were no significant differences in resting or exercise heart rates, pulmonary wedge pressures, cardiac outputs, left or right ventricular ejection fractions, left ventricular peak filling rates, or time to peak filling between the studies at 1 and 2 years. Only resting right atrial pressure increased between year 1 and year 2 (6 +/- 2 mm Hg vs 8 +/- 4 mm Hg, p = 0.035). These data demonstrate that cardiac allograft function is unchanged between 1 and 2 years after transplantation, despite episodes of intervening rejection and continued immunosuppression. The data further suggest that the previously reported decrease in cardiac allograft compliance does not appear to be caused by a progressive intrinsic abnormality in the allograft, and that other mechanisms for \"restrictive\" allograft physiology should be sought.","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 2","pages":"119-23"},"PeriodicalIF":0.0,"publicationDate":"1990-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13470140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Relationship between preoperative pulmonary status and outcome after heart transplantation. 心脏移植术后术前肺状态与预后的关系。

The Journal of heart transplantation Pub Date : 1990-03-01

L M Bussieres, C J Cardella, P A Daly, T E David, C M Feindel, A S Rebuck

{"title":"Relationship between preoperative pulmonary status and outcome after heart transplantation.","authors":"L M Bussieres, C J Cardella, P A Daly, T E David, C M Feindel, A S Rebuck","doi":"","DOIUrl":"","url":null,"abstract":"To determine whether routine preoperative pulmonary function tests provide useful prognostic information in orthotopic heart transplant candidates, we evaluated the pulmonary status of 33 patients who subsequently underwent transplantation. There was one perioperative death and five other fatalities within 9 months after operation. Mean age of the six patients who died (mean +/- SD 51.8 +/- 5.0 years) was significantly different (p less than 0.05) from that of the survivors (44.6 +/- 11.1 years). Mean preoperative pulmonary vascular resistance was significantly different (p less than 0.05) between those patients who had a fatal outcome (mean, 4.4 +/- 2.0 mm Hg/L/min) and those who survived (2.7 +/- 1.0 mm Hg/L/min). By contrast, we found that measures of forced vital capacity, forced expired volume in 1 second, diffusion capacity for carbon monoxide, and arterial blood gases bore no apparent relationship to outcome. We conclude that standard noninvasive measures of pulmonary function may be useful in preoperative preparation of heart transplant candidates, but they do not appear to be helpful in predicting eventual outcome.","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 2","pages":"124-8"},"PeriodicalIF":0.0,"publicationDate":"1990-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13470141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Simple electrical model of the circulation to explore design parameters for a skeletal muscle ventricle. 简单的循环电模型，探讨骨骼肌心室的设计参数。

The Journal of heart transplantation Pub Date : 1990-03-01

S L Voytik, C F Babbs, S F Badylak

{"title":"Simple electrical model of the circulation to explore design parameters for a skeletal muscle ventricle.","authors":"S L Voytik, C F Babbs, S F Badylak","doi":"","DOIUrl":"","url":null,"abstract":"To efficiently investigate a variety of designs for an accessory skeletal muscle ventricle for circulatory assistance, we developed an electrical model of the human circulatory system. Heart and blood vessels were modeled as resistive-capacitive networks, pressures as voltages, blood flow as electric current, and the cardiac valves as diodes. Pumping of blood was simulated by the application of damped rectangular voltage pulses to the capacitances of the cardiac ventricles and the skeletal muscle ventricle. Three configurations of a skeletal muscle ventricle were studied: the apico-aortic, in which the skeletal muscle ventricle is interposed between the left ventricle and the abdominal aorta; the aorto-aortic, in which the skeletal muscle ventricle is interposed between the thoracic aorta and the abdominal aorta; and the atrial-aortic, in which the skeletal muscle ventricle is interposed between the left atrium and abdominal aorta. The three skeletal muscle ventricle designs were tested as counterpulsatile assist devices in simulations of the normal circulation and congestive heart failure. Performance of the various skeletal muscle ventricle designs was evaluated by comparing total output, mean left ventricular power expenditure, mean skeletal muscle ventricle power expenditure, and mean perfusion pressure of the skeletal muscle comprising the pouch. Under both normal heart and heart failure conditions, the apico-aortic design was superior to the aorto-aortic and to the atrial-aortic designs. With optimal stimulation parameters, the apico-aortic design reduced left ventricular minute work to 16% of normal during simulated heart failure while maintaining a viable resting cardiac output of 3.4 L/min.(ABSTRACT TRUNCATED AT 250 WORDS)","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 2","pages":"160-74"},"PeriodicalIF":0.0,"publicationDate":"1990-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13469205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Postoperative organic mental syndromes in lung transplant recipients. Toronto Lung Transplant Group. 肺移植受者术后器质性精神综合征。多伦多肺移植小组。

The Journal of heart transplantation Pub Date : 1990-03-01

J L Craven

引用次数: 0

Right ventricular assist and prostacyclin infusion for allograft failure in the presence of high pulmonary vascular resistance. 右心室辅助和前列环素输注对存在高肺血管阻力的同种异体移植物衰竭的治疗。

The Journal of heart transplantation Pub Date : 1990-03-01

D S Esmore, P M Spratt, J M Branch, A M Keogh, R P Lee, A E Farnsworth, M X Shanahan, V P Chang

{"title":"Right ventricular assist and prostacyclin infusion for allograft failure in the presence of high pulmonary vascular resistance.","authors":"D S Esmore, P M Spratt, J M Branch, A M Keogh, R P Lee, A E Farnsworth, M X Shanahan, V P Chang","doi":"","DOIUrl":"","url":null,"abstract":"The presence of high pulmonary vascular resistance (PVR) greater than 4 Wood units contributes to significant early posttransplant mortality, and remains a negative predictor of long-term survival. Current trends have been toward exclusion of the recipient with high PVR from the orthotopic procedure; elective heterotopic allograft placement is increasingly advocated. A patient with a PVR of 6 Wood units underwent orthotopic transplantation; the cardiac allograft from a 12 kg heavier donor was implanted after an ischemic time of 115 minutes. Early graft failure at 4 hours and subsequent cardiac arrest were followed by reinstitution of cardiopulmonary bypass, during which time optimal pharmacologic manipulation of the pulmonary vasculature was undertaken, including the use of high-dose prostacyclin. Refractory right heart failure indicated the requirement for right ventricular assistance (RVA) for patient survival. RVA with a Bio-Medicus pump was instituted in association with high-dose prostacyclin; an intraaortic balloon pump was inserted 12 hours later. Maintenance immunosuppression consisted of cyclosporine and azathioprine alone. RVA was maintained for 3 days; during this time the patient was totally pump dependent. Over an 18-hour period the patient was weaned and successfully withdrawn from RVA. Intraaortic balloon pump counterpulsation and the prostacyclin infusion were continued for 6 and 10 days, respectively. The clinical implications of the various interventions that resulted in the patient's survival are discussed.","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 2","pages":"136-41"},"PeriodicalIF":0.0,"publicationDate":"1990-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13263778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Predictors of hospital length of stay after heart transplantation. 心脏移植术后住院时间的预测因素。

The Journal of heart transplantation Pub Date : 1990-03-01

K L Grady, K B Haller, B B Grusk, J W Corliss

{"title":"Predictors of hospital length of stay after heart transplantation.","authors":"K L Grady, K B Haller, B B Grusk, J W Corliss","doi":"","DOIUrl":"","url":null,"abstract":"Factors that predict hospital length of stay after heart transplantation were identified from retrospective data of 65 patients (82% male, mean age, 43.3 years). Multiple regression analysis with a stepwise procedure was used to generate three predictive models for length of stay: (1) a model to be used before operation, (2) a model that combines preoperative and donor information, and (3) a model that takes preoperative, donor, and postoperative factors (complete model) into consideration. Hospital length of stay ranged from 15 to 45 days after heart transplantation (median length of stay, 22.5 days; mean length of stay, 24.4 +/- 6.4 days). In the preoperative model, diagnosis, duration of cardiac symptoms, severity of heart failure, and pulmonary vascular resistance were significantly related to length of stay and together accounted for 36% of the variance in length of stay. When donor information (for example, size and ischemic time) was added to preoperative information, the resultant model failed to account for appreciably more of the variance in length of stay. A model that considered preoperative, donor, and postoperative factors accounted for 71% of the variance in length of stay. Significant variables in the model were the month in which the patient had transplantation in the program, duration of cardiac symptoms before transplantation, preoperative severity of heart failure, pulmonary vascular resistance, and postoperative incidence of severe acute rejection. Patient age, sex, and postoperative infections were not related to length of stay. In conclusion, there are cardiopulmonary and immunologic factors that can predict length of stay. The model also suggests that a program's experience with heart transplantation affects length of stay.","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 2","pages":"92-6"},"PeriodicalIF":0.0,"publicationDate":"1990-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13335528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0