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. · Dec 2004
Case ReportsNesiritide use in pediatric patients with congestive heart failure.
Nesiritide (B-type natriuretic peptide) is one of the newest therapies available in the treatment of adults with decompensated congestive heart failure (CHF). It rapidly improves hemodynamics and induces diuresis in adult patients with moderate to severe CHF. ⋯ As described in adults, our patients generally diuresed and had symptomatic improvement in response to the infusion with only dose-related hypotension and asymptomatic hyponatremia as recognized side effects. Given the number of pediatric patients who progress to CHF as a result of myocarditis, cardiomyopathy, or failed palliation for complex congenital heart disease, we believe nesiritide has a role in managing acutely decompensated CHF in the pediatric population.
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J. Heart Lung Transplant. · Dec 2004
Yield of surveillance bronchoscopy for acute rejection and lymphocytic bronchitis/bronchiolitis after lung transplantation.
Better understanding of the timing and pattern of surveillance bronchoscopy findings after lung transplantation could influence the timing and frequency of surveillance bronchoscopy. We present our surveillance bronchoscopy experience and test the hypothesis that patients not encountering early acute rejection or lymphocytic bronchitis/bronchiolitis are less likely to have subsequent occult occurrences in the 1st year after lung transplantation. ⋯ Surveillance bronchoscopy detects occult acute rejection or lymphocytic bronchitis/bronchiolitis in approximately one-third of biopsy specimens during the 1st year, with the majority of late abnormalities being minimal (A1) rejection. The absence of acute rejection or lymphocytic bronchitis/bronchiolitis during the first 100 days does not predict freedom from such events in the remainder of the 1st year.
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J. Heart Lung Transplant. · Dec 2004
Mechanical support for isolated right ventricular failure in patients after cardiotomy.
Patients with acute right ventricular (RV) failure after cardiotomy have a poor prognosis. We evaluated the surgical and long-term outcomes of patients with isolated RV failure that required right ventricular assist device (RVAD) support. ⋯ After cardiotomy, patients with RV failure who require mechanical support continue to have increased mortality. For patients successfully weaned from the RVAD, residual RV dysfunction is compatible with survival. More liberal use of RV mechanical support may be indicated for patients with acute RV failure.
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Fungal infections are an important complication of lung transplantation, but no controlled studies of their management have been performed. Knowledge of actual anti-fungal strategies may aid in the design of future prospective studies. ⋯ The majority of surveyed lung transplant programs actively manage fungal infection with prophylaxis or pre-emptive therapy, despite the absence of controlled trials. This survey may provide an impetus and a basis for designing prospective studies.