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 1995
Reduced work of breathing after single lung transplantation for emphysema.
Pulmonary emphysema, with or without chronic bronchitis, has emerged as the most common indication for successful single lung transplantation. Although gas exchange can be expected to improve after successful transplantation, such changes do not adequately explain the improvement in dyspnea experienced by these patients and resulting in improved quality of life. ⋯ The decline in lung compliance after single lung transplantation reflects the importance of improvement in elastic recoil and reduced chest wall distention, improving the work of breathing. The 67% decline in static lung compliance (300% increase in elastic recoil) is probably the single most important mechanical factor leading to reduced dyspnea after single lung transplantation for emphysema.
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J. Heart Lung Transplant. · Jan 1995
Association of pretransplantation antiheart antibodies with clinical course after heart transplantation.
Sera from 129 patients awaiting heart transplantation were assayed for the presence of IgM and IgG antiheart antibodies by means of sodium dodecyl sulphate-polyacrylamide gel electrophoresis and Western blotting. The patients' posttransplantation clinical course was assessed with regard to the amount of methylprednisolone, rabbit antithymocyte globulin, and OKT3 anti-T cell antibody, and the number of biopsy-confirmed rejection episodes. Before undergoing heart transplantation, approximately half the patients had weak IgM (45%) and weak IgG (48%) antiheart antibodies. However, 22.5% of the patients had strong IgM antiheart antibodies before transplantation, and they required more methylprednisolone than those who were negative and weak and approximately twice as much rabbit antithymocyte globulin as those who were negative, weak, or moderate. Six of the patients in this group required OKT3 therapy, and additionally they had a significantly greater number of rejection episodes than those patients who were negative (p = 0.006), or who had weak antiheart antibodies before transplantation (p = 0.001). ⋯ Analysis of the pattern of banding of strong IgM antiheart antibody sera showed antiheart antibodies most frequently against myocardial proteins of 35, 42, 50, 60, 70, 110, 120, 150, 180, and 200 kDa. Several of these proteins were characterized by two-dimensional polyacrylamide gel electrophoresis and Western blotting as tropomyosin (35 kDa), actin (42 kDa), heat shock protein 60 (60 kDa), and heat shock protein 70 (70 kDa). All strong antiheart antibody sera showed reactivity against a 200 kDa protein corresponding to myosin heavy chain.
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J. Heart Lung Transplant. · Jan 1995
Availability and selection of donors for pediatric heart transplantation.
Applying generally accepted criteria for selection of adult heart donors, we conducted a retrospective study of brain-dead infants and children for assessment of suitability as donors for heart transplantation. Cardiac histopathologic studies were evaluated in all subjects undergoing autopsy. ⋯ The supply of donor organs for pediatric heart transplantation is very limited if selection criteria used for adult donors are applied. These criteria, however, do not correlate well with myocardial pathologic findings in infants and children. More accurate predictors of donor suitability are needed.
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J. Heart Lung Transplant. · Jan 1995
Load-independent analysis of a pulsatile right ventricular assist device.
Right ventricular assist devices are becoming increasingly used as both a bridge to heart transplantation and as a means of temporary support after cardiopulmonary bypass. There has also been a resurgence of interest in pulsatile devices fueled by anecdotal, clinical reports. However, a load-independent analysis of biventricular function after right ventricular assistance comparing a pulsatile versus a continuous-flow right ventricular assist device has not been performed, and we hypothesize that a pulsatile device is less detrimental to cardiac function than a conventional, nonpulsatile pump. ⋯ We conclude from these data that pneumatically driven pulsatile right ventricular assist devices provide no additional benefit to myocardial performance beyond that of conventional, nonpulsatile pumps. Further studies investigating a speculative benefit from pulsatile circulatory support are necessary to further define a potential role for these novel devices.
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J. Heart Lung Transplant. · Jan 1995
Case ReportsUse of a pulsatile right ventricular assist device and continuous arteriovenous hemodialysis in a 57-year-old man with a pulsatile left ventricular assist device.
Despite advances in the perioperative treatment of both heart transplant and left ventricular assist device recipients, right-sided circulatory failure refractory to medical management remains a major source of morbidity in the immediate postoperative period. In addition, hypervolemia is a frequent complication encountered in the treatment of these patients because of their large fluid intake requirements and relative potential for kidney failure. ⋯ The use of right ventricular assist devices and continuous arteriovenous hemodialysis in both transplant and left ventricular assist device recipients undoubtedly will remain important as the popularity of these two therapeutic modalities continues to grow.