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. · Mar 1994
Randomized Controlled Trial Comparative Study Clinical TrialExercise, education, and quality of life in lung transplant candidates.
In addition to improved functional ability, patients who complete rehabilitation programs typically have positive psychologic changes, including increased motivation and an enhanced quality of life. Potentially, patients with end-stage lung disease awaiting a lung transplant can have similar benefits. However, no studies were identified that examined the impact of an exercise program on quality of life in patients awaiting lung transplantation. ⋯ Findings suggest that patients awaiting lung transplantation perceived improved quality of well-being and increased walk distance after participation in a health maintenance program. Education plus exercise conferred no benefits beyond those achieved by education alone. However, the number of subjects studied was small and duration of follow-up was limited.
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J. Heart Lung Transplant. · Mar 1994
Segmental flow-resistance relationship in pulmonary lobar transplantation: possibility for donor lobe evaluation in pediatric lung transplantation.
Pulmonary lobar transplantation is an option for pediatric lung transplantation, and it has the potential of extended applications. We compared the relationship between segmental blood flow and segmental vascular resistance of the pulmonary lobe with that of the transplanted single lung. Eight of 14 puppies received a left upper pulmonary lobe from double-weighed adult dogs, and the other six puppies received a left lung from puppies. ⋯ Segmental resistance of the lung at rest significantly increased from pretransplantation to 1 hour after transplantation (pulmonary lobe group, 2211 +/- 42 to 2555 +/- 61 dyne.sec.cm-5; single lung group, 2126 +/- 56 to 2557 +/- 72 dyne.sec.cm-5) and recovered 2 weeks after transplantation in both groups. However, by means of partial clamp of the right pulmonary artery, segmental resistances of 1 hour after transplantation pulmonary lobe (2248 +/- 37 dyne.sec.cm-5), and single lung (2206 +/- 34 dyne.sec.cm-5) at the same segmental flow of the pretransplantation state (310 to 320 ml/min) were equivalent to those of the pretransplantation lungs. There was no significant difference in the segmental resistance at any segmental flow between the pulmonary lobe and single lung before and after lung transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Heart Lung Transplant. · Mar 1994
Value of postoperative assessment of cardiac allograft function by transesophageal echocardiography.
Heart transplantation now provides an acceptable therapy for patients with severe end-stage heart disease. Although patient outcome has significantly improved both early and late after heart transplantation, early morbidity and mortality continues to affect overall survival and may be unpredictable. In an attempt to identify factors that may assist in predicting early outcome after orthotopic heart transplantation, we assessed allograft function in 16 patients in the immediate postoperative period, 30 minutes after weaning from cardiopulmonary bypass by measuring the fractional shortening of the left ventricle with transesophageal echocardiography. ⋯ Left ventricular fractional shortening 30 minutes after cardiopulmonary bypass was significantly lower in those patients requiring inotropic support (28.4% +/- 4.6% versus 43.7% +/- 3.5%, p < 0.05), whereas hemodynamic variables failed to distinguish these groups. In those patients requiring inotropes, there was a significant negative correlation of fractional shortening with the peak dose (r = -0.87, p < 0.01) and the duration of inotropic support (r = -0.62, p < 0.05). The total ischemic time of the allograft (206 +/- 22 minutes, range 77 to 359) did not correlate with the subsequent fractional shortening, but patients requiring inotrope support after the operation had significantly longer ischemic times (259 +/- 22 versus 138 +/- 22 minutes, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Heart Lung Transplant. · Mar 1994
Assessment of biventricular cardiac function in patients with a Novacor left ventricular assist device.
Novacor left ventricular assist devices were implanted in 10 patients. We used blood-pool radionuclide angiography and echocardiography to evaluate the response of the left and right ventricle to the left ventricular assist. Radionuclide angiography was done before and after implantation of the Novacor left ventricular assist devices in all cases. ⋯ In four patients partial aortic valve opening was noted. At an assist ratio of 1:3, complete opening of the aortic valve was noted in all cases (n = 9); the left ventricular ejection fraction decreased to 31%. We conclude that the Novacor left ventricular assist device substantially improves both right ventricular ejection fraction and left ventricular ejection fraction, although the aortic valve typically remains closed.