The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
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J. Heart Lung Transplant. · Jan 1993
Effects of triiodothyronine and vasopressin on cardiac function and myocardial blood flow after brain death.
Previous studies have documented decreases in serum-free triiodothyronine (T3) after brain death and improved hemodynamics with its replacement, suggesting its controversial, but promising, clinical utility for managing potential organ donors. Vasopressin is also commonly used clinically as a pressor agent after brain death. A load-independent analysis of cardiac function and an assessment of myocardial blood flow (MBF) with these agents have not been reported, however. ⋯ Analysis of endocardial to epicardial flow ratios disclosed no significant differences between groups at any time. In summary, animals treated with T3 had a greater decline in MBF than the control group at 4 hours, without any benefit to cardiac function. Further studies examining the mechanism responsible for the deterioration of MBF and cardiac dysfunction will be necessary to optimally manage the brain dead patient before organ harvest, especially regarding the precise role of T3.
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J. Heart Lung Transplant. · Jan 1993
Antibody formation after drug administration during cardiac surgery: parameters for aprotinin use.
Patients who require cardiac surgery or heart-lung transplantation may have been previously sensitized to drugs and blood products to which they may be reexposed during their current surgery. Reexposure may produce an anaphylactic reaction, a life-threatening allergic response. The presence of immunospecific immunoglobulin (Ig)E antibodies and, perhaps, certain classes of IgG antibodies may increase the risk of anaphylaxis. ⋯ The risk of anaphylaxis after protamine administration is much higher among neutral protamine Hagedorn insulin-dependent diabetic patients (0.6% to 2%) than among non-neutral protamine Hagedorn insulin-dependent diabetic patients (0.06%). However, patients with pulmonary hypertension or prior exposure to protamine from previous cardiac surgery were not at an increased risk for anaphylaxis after protamine exposure. The presence of preexisting IgE antibodies has been shown to be highly predictive of the development of anaphylaxis.(ABSTRACT TRUNCATED AT 250 WORDS)