The Journal of heart transplantation最新文献_第2页

Pediatric heart transplantation: surgical considerations for congenital heart diseases. 儿童心脏移植:先天性心脏病的手术考虑。

The Journal of heart transplantation Pub Date : 1990-11-01

C Chartrand, R Guerin, M Kangah, P Stanley

{"title":"Pediatric heart transplantation: surgical considerations for congenital heart diseases.","authors":"C Chartrand, R Guerin, M Kangah, P Stanley","doi":"","DOIUrl":"","url":null,"abstract":"Congenital anomalies of the atrium, of the pulmonary and systemic venous return, and of the great vessels are sometimes regarded as contraindications to heart transplantation. Among 10 children who underwent heart transplantation in our institution, five, aged 4 to 15 years and weighting 9 to 32 kg, previously operated on, had congenital anomalies. These lesions, encountered singly or in association, were single atrium (2), previous Mustard operation (1), hypoplastic left atrium (1), anomalous systemic venous return (3), anomalous pulmonary venous return (2), transposition or malposition of the great vessels (5), pulmonary artery hypoplasia (1). To enable correction of these lesions and to perform heart transplantation, the donor heart preparation was modified in four ways. The surgical techniques used for correcting these anomalies in this group were atrial septation, atrial enlargement, superior and inferior reroofing, double venous rerouting, septal realignment, full-length mobilization of the great vessels, and pulmonary artery reconstruction. All children survived operation and left the hospital in excellent condition. Follow-up ranged from 6 months to 3 years. All children are totally asymptomatic. As demonstrated by echocardiography, heart catheterization, and angiography, there are no stenoses, no shunts, and there is good atrial size and good orientation of the great vessels. On the basis of our experience, we conclude that with appropriate surgical techniques, most atrial, venous return, and intrapericardial great vessel anomalies are correctable at the time of orthotopic transplantation and that these techniques allow for a successful outcome in children.","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 6","pages":"608-16; discussion 616-7"},"PeriodicalIF":0.0,"publicationDate":"1990-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13428269","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 the total artificial heart and ventricular assist device as a bridge to transplantation. 使用全人工心脏和心室辅助装置作为移植的桥梁。

The Journal of heart transplantation Pub Date : 1990-11-01

R Pifarre, H Sullivan, A Montoya, M Bakhos, J Grieco, B K Foy, B Blakeman, R Altergott, V Lonchyna, D Calandra

{"title":"Use of the total artificial heart and ventricular assist device as a bridge to transplantation.","authors":"R Pifarre, H Sullivan, A Montoya, M Bakhos, J Grieco, B K Foy, B Blakeman, R Altergott, V Lonchyna, D Calandra","doi":"","DOIUrl":"","url":null,"abstract":"The proliferation of transplant programs has not been paralleled by a similar increase in the availability of organ donors. This has significantly prolonged the waiting period and consequently has resulted in increased mortality of the patients with end-stage heart disease who are awaiting transplantation. Between 1984 and 1987, 104 orthotopic heart transplants were performed at Loyola University Medical Center. During the same period, 25 patients died while waiting for a suitable donor. To reduce the mortality of our patients waiting for transplantation, we began using the total artificial heart and a ventricular assist device as a bridge to transplantation in 1988. Of 29 patients who underwent transplant procedures in 1988, 18 required either a total artificial heart (15) or a ventricular assist device (3) as a bridge to transplantation. The underlying heart conditions were ischemic cardiomyopathy (11), dilated cardiomyopathy (5), giant cell myocarditis (1), and allograft failure (1). The average duration of mechanical support was 10 days (range, 1 to 35 days). Seventeen of the supported patients had successful transplants. One patient had brain death and did not receive a heart transplant. Of the 17 patients who survived surgery, two died within 30 days: one at 17 days because of acute rejection, the other at 14 days because of a cerebral vascular event. Fifteen patients (83%) were long-term survivors. Nine of the supported patients required reoperation because of bleeding after device implantation. There was no mediastinal or incisional infection. While the mechanical device was in place, the activated clotting time was maintained between 170 and 200 seconds with the administration of heparin (400 to 1000 units per hour).(ABSTRACT TRUNCATED AT 250 WORDS)","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 6","pages":"638-42; discussion 642-3"},"PeriodicalIF":0.0,"publicationDate":"1990-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13427399","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

Malignant tumors after heart transplantation. 心脏移植后的恶性肿瘤。

The Journal of heart transplantation Pub Date : 1990-11-01

J P Couetil, J P McGoldrick, J Wallwork, T A English

{"title":"Malignant tumors after heart transplantation.","authors":"J P Couetil, J P McGoldrick, J Wallwork, T A English","doi":"","DOIUrl":"","url":null,"abstract":"Three hundred-thirteen heart transplant procedures were performed in 303 patients in the 10 years between January 1979 and December 1988. The incidence, histologic type, and site of malignant disease have been analyzed in the 275 patients (91%) who survived more than 1 month after heart transplantation. Four immunosuppressive regimens have been used during this period. Patients 1 through 29 received azathioprine and steroids with 28 days of intravenous antithymocyte globulin. Patients 30 through 89 received cyclosporine and low-dose steroids; the next 61 patients were randomized between cyclosporine and low-dose steroids and cyclosporine and azathioprine; and after patient 150 we have used triple therapy. All cyclosporine-based regimens have included a short course of prophylactic antithymocyte globulin. Eleven malignant tumors have been diagnosed, between 2 months and 6 years after the transplant procedure, and these have been treated by a variety of means. These tumors were two squamous cell carcinomas of the skin; a malignant anal wart that recurred after excision and radiotherapy and necessitated abdominoperineal resection: two small-cell carcinomas of the lung: one squamous cell carcinoma of the esophagus and one of the larynx; two carcinomas of the kidney were found at postmortem examinations; and there were two malignant lymphomas, one of which disseminated rapidly, whereas the other has had prolonged remissions with reduction in immunotherapy with acyclovir. These 11 tumors were responsible for four deaths. No relationship has been demonstrated between type of immunosuppression and tumor development. All patients who are immunosuppressed remain at increased risk for malignant changes. Close surveillance is needed to detect tumors at an early stage.","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 6","pages":"622-6"},"PeriodicalIF":0.0,"publicationDate":"1990-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13428270","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

Experimental heterotopic heart transplantation without ischemia or reperfusion. 无缺血再灌注的实验性异位心脏移植。

The Journal of heart transplantation Pub Date : 1990-11-01

H Lin, M D Iannettoni, J R Goldblum, S F Bolling

引用次数: 0

Successful use of mechanical assist device for right ventricular failure after orthotopic heart transplantation. 机械辅助装置在原位心脏移植后右心室衰竭中的成功应用。

The Journal of heart transplantation Pub Date : 1990-11-01

N J Odom, D Richens, B E Glenville, A J Kirk, C J Hilton, J H Dark

引用次数: 0

Antimyosin monoclonal antibodies for early detection of cardiac allograft rejection. 抗肌球蛋白单克隆抗体早期检测异体心脏移植排斥反应。

The Journal of heart transplantation Pub Date : 1990-11-01

A Schuetz, S Fritsch, B M Kemkes, C Kugler, C Angermann, C Spes, M Anthuber, A Weiler, K Wenke, J M Gokel

{"title":"Antimyosin monoclonal antibodies for early detection of cardiac allograft rejection.","authors":"A Schuetz, S Fritsch, B M Kemkes, C Kugler, C Angermann, C Spes, M Anthuber, A Weiler, K Wenke, J M Gokel","doi":"","DOIUrl":"","url":null,"abstract":"Sixty-eight indium 111-labeled antimyosin Fab-DTPA imaging studies (0.5 mg intravenously with a radioactivity of 65 to 75 MBq) were executed on 37 of 116 patients undergoing heart transplantation to assess diagnostic accuracy and clinical utility. As controls, 21 patients with cardiomyopathy (n = 8), unstable angina (n = 9), and myocardial infarction (n = 4) were selected. After 48 hours, single photon emission computed tomographic images were evaluated visually, and heart/lung ratios were measured, using the \"region of interest\" technique. They were compared with echocardiographic and endomyocardial biopsy results. In 40 studies a heart/lung ratio less than or equal to 1.6 corresponded to a negative biopsy result in 98% (40/41). Echocardiography enabled correct identification of 95% of the patients with normal biopsy findings. In 91% (22/24) a positive biopsy finding correlated with a heart/lung ratio greater than 1.6 including 20 mild rejections, but in only 64%, with an increase in wall thickness and/or decrease of fractional diameter shortening seen on echocardiogram. In addition, the various stages of rejection episodes determined the amount of the heart-lung ratio. There was a significant relationship between the histologic findings and the antimyosin uptake. In 13 patients a second investigation was performed after rejection therapy. All patients had a negative biopsy result, and the heart/lung ratio decreased to normal ranges (less than or equal to 1.6). Five antimyosin antibody studies were excluded, as in these cases, negative uptake results were found during rejection therapy with high-dose steroids. The overall sensitivity was calculated at 93% and the specificity at 98%.(ABSTRACT TRUNCATED AT 250 WORDS)","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 6","pages":"654-61"},"PeriodicalIF":0.0,"publicationDate":"1990-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13427403","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

A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: Lung Rejection Study Group. The International Society for Heart Transplantation. 心肺排斥反应诊断术语标准化的工作公式:肺排斥研究组。国际心脏移植学会。

The Journal of heart transplantation Pub Date : 1990-11-01

G J Berry, E M Brunt, D Chamberlain, R H Hruban, R K Sibley, S Stewart, H D Tazelaar

引用次数: 0

Some histopathologic aspects regarding onset of antirejection therapy after heart transplantation. 心脏移植后抗排斥治疗开始的一些组织病理学方面。

The Journal of heart transplantation Pub Date : 1990-11-01

J Kemnitz, B Heublein, A Haverich, T R Cohnert, R Hetzer, H R Zerkowski, M Altmannsberger, A Georgii

{"title":"Some histopathologic aspects regarding onset of antirejection therapy after heart transplantation.","authors":"J Kemnitz, B Heublein, A Haverich, T R Cohnert, R Hetzer, H R Zerkowski, M Altmannsberger, A Georgii","doi":"","DOIUrl":"","url":null,"abstract":"The histopathologic indication for starting antirejection therapy has so far been given by the diagnosis of moderate rejection in endomyocardial biopsies, that is, rejection with necroses of myocytes and predominantly lymphocytic infiltrates (corresponding to the descriptive diagnosis of moderate rejection in the Stanford classification, grade 4 and more in the Texas classification, and A-3 moderate rejection in the Hannover classification). Our present results, however, have shown that the critical limit for the onset of antirejection therapy may be fixed somewhat higher on the scale of severity of acute rejection and that it may be reasonable to define an affection of more than 20% of the total biopsy material by morphologic changes corresponding to the traditional definition of moderate acute rejection as the decisive histopathologic finding that should induce antirejection therapy. This means that the diagnosis of moderate rejection has to be divided into two groups: (1) A-3a moderate acute rejection not yet requiring therapy that, however, does necessitate bioptic control within 7 to 10 days; (2) A-3b moderate acute rejection requiring antirejection therapy. The introduction of this differentiation of histopathologic diagnoses is not just another sophisticated scientific theorem; its practical significance may be seen in a definitive restriction of the application of antirejection therapy, which means a reduction of the risks and side effects imposed on heart-transplanted patients by chemotherapy and particularly by steroid therapy.","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 6","pages":"662-7"},"PeriodicalIF":0.0,"publicationDate":"1990-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13427404","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

The Journal of heart transplantation Pub Date : 1990-11-01

M A Vasu

引用次数: 0

Meningism in a ten-month-old infant during OKT3 therapy. OKT3治疗期间10个月婴儿脑膜炎。

The Journal of heart transplantation Pub Date : 1990-11-01

J D Rizzo, S A Rowe

引用次数: 0