The Journal of heart transplantation最新文献_第8页

Dilemma of variety of histopathologic grading systems for acute cardiac allograft rejection by endomyocardial biopsy. 不同的组织病理学分级系统对急性同种异体心脏移植排斥反应的困境。

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

M E Billingham

{"title":"Dilemma of variety of histopathologic grading systems for acute cardiac allograft rejection by endomyocardial biopsy.","authors":"M E Billingham","doi":"","DOIUrl":"","url":null,"abstract":"From the International Society for Heart Transplantation Registry, it can be seen that more than 2000 hearts are now being transplanted per year and that this number is likely to continue to rise. Because the leading causes of death in the first year after heart transplantation are infection and acute rejection, it is clear that the problem of managing heart recipients becomes that of correctly diagnosing acute rejection. For many years the endomyocardial biopsy has provided a safe, reliable, morphologic index of acute rejection. Notwithstanding the drawback of an invasive technique and sampling error, the endomyocardial biopsy has prevailed as the single most reliable method for diagnosing acute rejection. In 1974 a grading system for the diagnosis of acute rejection from biopsy material was first described. Since then, the grading system has been updated, and over the years many different grading systems have evolved to accommodate better the style of managing heart recipients in different centers worldwide. Although this is satisfactory for individual centers, it has become clear that there is difficulty in comparison of different treatment regimens from transplant centers using different grades. For continued improvement of survival in heart recipients, multicenter trials using different treatment and management protocols must be tried. To accomplish this, direct comparisons between one regimen and another must be made. For this purpose, a universal grading system has been suggested. This article makes an initial attempt to point out the weaknesses and strengths of the current grading systems and an initial attempt to define the criteria that would be accepted in a universal, or standard, grading system.","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 3 Pt 2","pages":"272-6"},"PeriodicalIF":0.0,"publicationDate":"1990-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13503501","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

Dynamic cardiomyoplasty in patients. 患者动态心肌成形术。

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

G J Magovern, S B Park, R L Kao, I Y Christlieb, G J Magovern

{"title":"Dynamic cardiomyoplasty in patients.","authors":"G J Magovern, S B Park, R L Kao, I Y Christlieb, G J Magovern","doi":"","DOIUrl":"","url":null,"abstract":"Dynamic cardiomyoplasty has been used to correct cardiac defects, augment contraction of weakened myocardium, and support circulation of end-stage heart disease patients by using their own skeletal muscle after electric conditioning. Five patients, each with a history of myocardial infarction and diffused coronary artery disease, underwent the application of the left latissimus dorsi muscle over the anterolateral wall or around the ventricles. In all patients the left latissimus dorsi muscle was dissected free from all insertions with careful preservation of the thoracodorsal nerve and vessels. The freed muscle flap was internalized into the thoracic cavity with the humeral tendinous end of the muscle sutured to the periosteum of the second or third rib after subperiosteum resection of a portion of the rib. The muscle flap was used in three of the five patients for ventricular wall repair after aneurysmectomy. In the other two patients the muscle was applied over the ventricles for functional augmentation. The skeletal muscle was electrically conditioned to contain mainly fatigue-resistant muscle fibers and was stimulated to contract synchronously with the heart. All patients survived the operation, with immediate improvement of ventricular function for those who had had aneurysmectomy. A significant increase in ejection fraction was observed in three of the five patients when the pacemaker was turned on. One patient died of sudden ventricular arrhythmia 2 months after the operation. The last patient is doing well at 6 weeks after operation. The first patient has been followed up for more than 3 years and continues to do well.(ABSTRACT TRUNCATED AT 250 WORDS)","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 3 Pt 1","pages":"258-63"},"PeriodicalIF":0.0,"publicationDate":"1990-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13503497","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

Retrospective analysis of the psychologic effects of mechanical circulatory support. 机械循环支持的心理效应回顾性分析。

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

S A Ruzevich, M T Swartz, J E Reedy, D F Termuhlen, L R McBride, S M Frese, D G Pennington

{"title":"Retrospective analysis of the psychologic effects of mechanical circulatory support.","authors":"S A Ruzevich, M T Swartz, J E Reedy, D F Termuhlen, L R McBride, S M Frese, D G Pennington","doi":"","DOIUrl":"","url":null,"abstract":"There is an increasing need to evaluate the psychologic impact of circulatory support because of the growing use of mechanical assist devices. Twenty-seven people, 12 survivors of mechanical circulatory assistance and 15 family members, were surveyed; nonsurvivors' families were not surveyed. The 12 survivors (ages 18 to 66 years; mean, 43 years) had been supported with Pierce-Donachy ventricular assist devices (nine patients) and the Novacor left ventricular assist system (one patient). One patient received a centrifugal pump, and one was supported with extracorporeal membrane oxygenation (ECMO). Duration of support ranged from 8 hours to 90 days (mean, 23 days). Ten people surveyed were spouses of these patients, and five were parents of children who had been supported with ECMO. Three patients were supported longer than 3 weeks, and four patients were awake and ambulatory during support. Financial worries were not a concern for 80% of the parents but were a concern for 80% of the spouses. Eighteen percent of the patients believed they were treated as an experiment, whereas 40% of their spouses thought they were. None of the parents thought their child was treated as an experiment. Sixty-seven percent of the patients stated that they have returned to a normal life-style, and 75% feel they have a brighter outlook on life. Six patients have returned to work, two are retired, two are disabled, and two have physical capabilities to work but choose not to. Eighty-nine percent of all those surveyed would recommend an assist device to someone who needed one. Although these procedures are often associated with severe medical and psychologic complications, 74% of the patients would agree to a second implant.","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 3 Pt 1","pages":"209-12"},"PeriodicalIF":0.0,"publicationDate":"1990-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13504310","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

Acute physiologic changes after extended pulmonary preservation. 延长肺保存后的急性生理变化。

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

R S Bonser, L S Fragomeni, K Harris, B J Edwards, R J Fischel, D Rotenberg, S W Jamieson, M P Kaye

{"title":"Acute physiologic changes after extended pulmonary preservation.","authors":"R S Bonser, L S Fragomeni, K Harris, B J Edwards, R J Fischel, D Rotenberg, S W Jamieson, M P Kaye","doi":"","DOIUrl":"","url":null,"abstract":"The physiologic effects of 12-hour lung preservation were assessed in six mongrel dogs studied for 20 hours after double-lung allograft implantation. Donor animals were pretreated with allopurinol (30 mg/kg) and methylprednisolone (500 mg) intravenously at anesthesia induction. Heart-lung blocks were harvested after cardioplegic arrest, and a simple pulmonary artery flush of 4 degrees C modified Collins' solution was administered at 15 ml/kg/min. The lungs were ventilated with 100% nitrogen during flushing and inflation. Recipient animals received an infusion of deferoxamine (20 mg/kg) during implantation and were pretreated with methylprednisolone (500 mg) intravenously. All six implantations were technically successful. Two animals died of cardiac standstill 12 and 24 hours postoperatively. Gas exchange deteriorated after implantation compared with donor levels but remained in a range compatible with survival, and at 20 hours arterial oxygen tension (FiO2 0.4) was 138 +/- 91 mm Hg. Similar changes were seen in alveolar-arterial oxygen gradients and arterial-alveolar oxygen tension fraction. Elimination of carbon dioxide was satisfactory. Pulmonary venous shunt fraction rose significantly at the end of the study. Hemodynamic changes consisted of a gradual increase in pulmonary vascular resistance and a reduction in cardiac output. Lung mechanics also deteriorated, with a gradual rise in airway resistance and a fall in compliance. The double-lung model allows detailed assessment of the early effects of preservation and may have certain advantages over heart-lung models of preservation. The preservation technique warrants further study.","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 3 Pt 1","pages":"220-9"},"PeriodicalIF":0.0,"publicationDate":"1990-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13503494","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

Histologic prognostic indicators for the lung allografts of heart-lung transplants. 同种异体肺移植的组织学预后指标。

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

C Clelland, T Higenbottam, B Otulana, S Stewart, G Igboaka, J Scott, R Smyth, J Wallwork

{"title":"Histologic prognostic indicators for the lung allografts of heart-lung transplants.","authors":"C Clelland, T Higenbottam, B Otulana, S Stewart, G Igboaka, J Scott, R Smyth, J Wallwork","doi":"","DOIUrl":"","url":null,"abstract":"The histologic changes in transbronchial lung biopsy specimens of heart-lung transplant patients were graded during episodes of acute rejection and when patients were well. Infection was strictly excluded from all episodes studied. Grade of severity of rejection was determined by the magnitude and extent of the inflammatory infiltrate. Biopsy specimens, obtained 1 year after the initial biopsies, were examined for histologic evidence of airway submucosal fibrosis, and each patient's clinical status at this time was recorded. The biopsy material from 22 long-term survivors was studied. On 16 occasions the specimens showed no evidence of rejection (grade 0). Twelve of these sets of specimens were from clinically well patients, and four were from the patients who had clinical evidence of rejection. The other six sets of specimens, from clinically well patients, showed evidence of rejection: three grade 1 and three grade 2. One year later, the clinically well patients had normal biopsy histology without fibrosis and normal lung function. Bronchiolitis obliterans had not developed in any patient. There were 27 episodes of rejection in the 22 patients, of which 23 were confirmed histologically. Eleven sets of specimens had grade 1 acute rejection, eight grade 2, and four grade 3. Three of these patients died, and bronchiolitis obliterans was confirmed at necropsy. Lung fibrosis was more common in specimens taken after 1 year, and lung function was depressed in these patients. The histologic grading of transbronchial lung biopsy material, although still in the early stages of development, provides some predictive value to the long-term outcome of the lung transplant patient, in development of both bronchiolitis obliterans and lesser fibrotic changes.","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 3 Pt 1","pages":"177-85; discussion 185-6"},"PeriodicalIF":0.0,"publicationDate":"1990-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13504306","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

Coronary vascular reactivity after heart transplantation in dogs: nitroglycerin-induced response. 狗心脏移植后冠状动脉血管反应性:硝酸甘油诱导的反应。

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

L Dumont, C Chartrand

{"title":"Coronary vascular reactivity after heart transplantation in dogs: nitroglycerin-induced response.","authors":"L Dumont, C Chartrand","doi":"","DOIUrl":"","url":null,"abstract":"Coronary reactivity during rejection still remains an unresolved question. Evidence of residual coronary dilator reserve would lend support to the therapeutic approach of increasing myocardial blood flow during episodes of acute rejection. This hypothesis was tested in canine heart transplants. Fourteen orthotopic heart transplantations were performed and electronic implants were positioned for long-term hemodynamic studies. Of the 14 study dogs, nine were nonimmunosuppressed; five dogs with transplants received standard triple therapy (cyclosporine, azathioprine, and prednisone). Nitroglycerin challenge consisted of an intravenous bolus administration at a dose of 4 to 5 micrograms/kg. This pharmacologic challenge was performed 3 hours after surgery, 2 to 3 days after transplantation, and 24 hours or less before death for the nonimmunosuppressed group. Nitroglycerin always exerted its peripheral vasodilator effect: arterial pressure decreased by 20% and total peripheral resistance by 25% to 35%, which favors the observed increment in cardiac index. There were, however, significant differences in the cardiac effect of nitroglycerin: during acute rejection this effect was severely blunted (less than 10%). On the contrary, coronary blood flow always increased after nitroglycerin administration (40% in the postoperative period, 42% in immunosuppressed dogs, and 33% during acute rejection). These results indicate that nitroglycerin elicits its coronary vasodilator effect despite acute rejection episodes. The concept of a functional reversible vasoconstrictor component present during acute rejection gains support from this study and brings a challenging new avenue for therapeutic approaches.","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 3 Pt 1","pages":"213-8; discussion 219"},"PeriodicalIF":0.0,"publicationDate":"1990-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13268319","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

Treating cardiac allograft rejection: present approach--analysis of 100 consecutive patients. 治疗同种异体心脏移植排斥反应:目前的方法——连续100例患者的分析。

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

B Radovancevic, S Birovljev, O H Frazier

引用次数: 0

Histologic grading of cardiac allograft rejection: a quantitative approach. 同种异体心脏移植排斥反应的组织学分级:定量方法。

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

H A McAllister

引用次数: 0

Treatment of cardiac allograft rejection with intravenous corticosteroids. 静脉注射皮质类固醇治疗同种异体心脏移植排斥反应。

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

L W Miller