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. · May 1994
Comparative StudyFlail tricuspid leaflet after multiple biopsies following orthotopic heart transplantation: echocardiographic and hemodynamic correlation.
Flail tricuspid leaflet has been reported as a relatively uncommon complication of endomyocardial biopsy in orthotopic heart transplant recipients. However, the relationship of this complication to the number of biopsies performed and to the site of access for biopsy is not known. The objectives of this study were to assess the prevalence of flail tricuspid leaflet/torn chordae tendineae in our recent transplant population, define the relationship of this complication to endomyocardial biopsy, and to correlate echocardiographic assessments of tricuspid regurgitation severity with hemodynamic data obtained at cardiac catheterization. ⋯ The mean number of biopsies performed per patient was 15.5 (range, 2 to 27). The mean severity of tricuspid regurgitation by echocardiography was grade 3 (moderate); seven patients (33%) had severe regurgitation. The mean right atrial v wave by catheterization was 15 mm Hg (range, 6 to 26 mm Hg).(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Heart Lung Transplant. · May 1994
Comparative StudyInhaled nitric oxide in the evaluation of heart transplant candidates with elevated pulmonary vascular resistance.
The reversibility of elevated pulmonary vascular resistance in heart transplant candidates is currently evaluated with intravenous vasodilators. The aim of this study was to evaluate the effects of increased concentrations of inhaled nitric oxide (20, 40, and 80 ppm) on central hemodynamics and right ventricular function in heart transplant candidates with elevated pulmonary vascular resistance (> 2.5 Wood units). Comparison was made with intravenous vasodilators, sodium nitroprusside, and prostacyclin in doses that lowered the mean arterial pressure by about 15%. ⋯ The pulmonary vascular resistance/systemic vascular resistance ratio, used as an index of pulmonary selectivity, was decreased by nitric oxide (p < 0.01) but not by the intravenous vasodilators. Metabolic data indicate that inhaled nitric oxide is metabolized in the same way as that formed endogenously. In conclusion, inhaled nitric oxide is a selective pulmonary vasodilator that can be used safely in the hemodynamic evaluation of heart transplant candidates with elevated pulmonary vascular resistance.
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J. Heart Lung Transplant. · May 1994
Deleterious effects of cardiopulmonary bypass on early graft function after single lung allotransplantation: evaluation of a heparin-coated bypass circuit.
Clinical lung transplantation may necessitate the use of cardiopulmonary bypass during the procedure, resulting in increased morbidity with more severe early graft dysfunction and increased blood loss. A heparin surface-coated cardiopulmonary bypass circuit is now available with improved biocompatibility and reduced systemic heparin requirements and may offer advantages compared with standard uncoated cardiopulmonary bypass circuits. This study investigates in a canine model of single-lung allotransplantation whether cardiopulmonary bypass adversely affects early graft function and whether a heparin-coated cardiopulmonary bypass circuit with reduced systemic heparin dosage improves results compared with standard uncoated cardiopulmonary bypass systems. ⋯ After reperfusion, cardiac index and mean arterial pressure were significantly reduced in the groups with uncoated circuits and with heparin-coated circuits compared with the group that did not undergo cardiopulmonary bypass (p < 0.001). Postoperative blood loss was significantly less (p < 0.002) in the group that did not undergo cardiopulmonary bypass (90 ml +/- 38 ml) compared with both the group with uncoated circuits (750 +/- 15 ml) and the group with heparin-coated circuits (690 +/- 387 ml), with no significant difference between the groups that underwent bypass. The use of cardiopulmonary bypass with systemic heparinization is detrimental to early graft function in this canine model of left single-lung allotransplantation.(ABSTRACT TRUNCATED AT 400 WORDS)