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. · Feb 2004
Case ReportsDobutamine-related asthma in a patient awaiting cardiac transplantation: the eosinophilic dilemma.
Long-term continuous intravenous inotrope infusion is frequently used as a pharmacologic bridge to cardiac transplantation in patients with end-stage congestive heart failure. We report a case of severe eosinophil-associated asthma after 6 weeks of therapy with the inotrope dobutamine in a patient awaiting cardiac transplantation. Review of the laboratory data revealed a steady increase in eosinophils during the period of treatment with dobutamine. Once the patient was switched to an alternative inotrope, milrinone, the eosinophil count returned to normal, and the asthma exacerbation resolved.
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J. Heart Lung Transplant. · Feb 2004
Right ventricle-sparing heart transplantation effective against iatrogenic pulmonary hypertension.
Right heart failure is the predominant cause of death following heart transplantation, occurring with disturbingly high frequency in patients with severe antecedent pulmonary hypertension. We have recently reported a novel technique of heart transplantation that spares the recipient right ventricle, excising only the recipient left ventricle. The resulting model has 2 right hearts and 1 left heart. The aim is to preserve the recipient's right ventricle, which is already conditioned to pulmonary hypertension. The hope is that, in this way, death due to right heart failure can be prevented in humans. Our prior report was a feasibility study in normal dogs. This study challenges this new technique by creating iatrogenic pulmonary hypertension in the recipient animals. ⋯ Right ventricle-sparing heart transplantation ("one-and-one-half heart model") can handle pulmonary hypertension without difficulty. This evidence adds impetus for further pursuing of right ventricle-sparing heart transplantation to decrease the incidence of death from right heart failure in recipients with severe antecedent pulmonary hypertension.