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 2008
Comparative StudyUse of the percutaneous left ventricular assist device in patients with severe refractory cardiogenic shock as a bridge to long-term left ventricular assist device implantation.
For patients with persistent cardiogenic shock refractory to intraaortic balloon pump (IABP) support, there are only limited means of resuscitation and bridging to surgical left ventricular assist device (LVAD) implantation. Extracorporeal membrane oxygenation and emergency surgical approaches have been attempted but are associated with significant morbidity and mortality. We evaluated the efficacy of a percutaneous left ventricular assist device (PVAD) as a bridge to LVAD implantation in patients in cardiogenic shock refractory to IABP and pressor support. ⋯ In patients with terminal hemodynamic collapse, PVAD support is an effective bridging therapy to LVAD and appears to be a viable alternative to other invasive methods of support.
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J. Heart Lung Transplant. · Jan 2008
Case ReportsConnecting the Centrimag Levitronix pump to Berlin Heart Excor cannulae; a new approach to bridge to bridge.
An increasing number of children are requiring circulatory support. Hospitals offering pediatric Ventricular Assist Device (VAD) should have devices of different sizes available to cover the full range of patient sizes incurring considerable expense. As in adults, post-operative bleeding often complicates VAD implantation. The use of a Levitronix Centrimag centrifugal pump, connected to Berlin Heart Excor cannulae, seems an attractive and logic combination, both in terms of patient safety and of hospital economics. ⋯ The Levitronix Centrimag pump was easy to handle and gave effective circulatory support, the patients were only switched to the Berlin Heart Excor system after stabilization. In patients with a high risk of failure, it is a relatively cheap but safe and effective support system.
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J. Heart Lung Transplant. · Jan 2008
Relationship of immunosuppression to Epstein-Barr viral load and lymphoproliferative disease in pediatric heart transplant patients.
Post-transplant lymphoproliferative disease (PTLD) is a severe complication in transplant recipients. Detection of increased Epstein-Barr viral (EBV) load in the peripheral blood acts as a surrogate marker for increased risk of PTLD development. We prospectively monitored EBV load, immunosuppression and PTLD in pediatric heart transplant (HTx) patients to determine risk factors for an increased EBV load and risk of PTLD. ⋯ Frequent EBV load monitoring identifies patients at high risk for PTLD development. Azathioprine and ATG are major risk factors for increased EBV load and PTLD and patients may benefit from a change of immunosuppression in addition to pre-emptive anti-viral or anti-tumor strategies.
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J. Heart Lung Transplant. · Jan 2008
Assessment of pulmonary artery systolic pressures by stress Doppler echocardiography after bilateral lung transplantation.
Even after successful single-lung transplantation (SLTx) or bilateral lung transplantation (BLTx), patients continue to have peripheral muscle weakness and exercise impairment. After SLTx, exercise limitation is also attributed to persistent or recurrent pulmonary vascular abnormalities with elevated pulmonary arterial pressures at rest or during exercise. Therefore, the aim of this study was to evaluate systolic pulmonary artery pressures (PASPs) at rest and during supine bicycle exercise, exercise capacity and cardiopulmonary function in post-BLTx patients. ⋯ Reduced exercise capacity of patients after BLTx due to end-stage pulmonary hypertension is not attributed to persistent or recurrent manifest pulmonary hypertension or cardiopulmonary dysfunction. Nevertheless, latent pulmonary hypertension with exaggerated pulmonary artery pressures during exercise may occur in some patients.
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J. Heart Lung Transplant. · Jan 2008
Relationship between natriuretic peptides and inflammation: proteomic evidence obtained during acute cellular cardiac allograft rejection in humans.
Cardiac natriuretic peptides (NPs) atrial natriuretic factor (ANF) and brain natriuretic peptide (BNP) are polypeptide hormones secreted by the heart. Previously, we found that BNP, but not ANF, plasma levels may increase during an acute cellular cardiac allograft rejection episode. In vitro, the pro-inflammatory cytokines interleukin-1beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha) produced a selective increase of BNP gene expression and secretion. Other pro-inflammatory cytokines had no such effects. ⋯ This work shows that cytokines other than pro-inflammatory cytokines correlate with BNP plasma levels observed during acute cardiac allograft rejection, and that the substances identified have in common p38 signaling. This finding provides a unifying mechanistic explanation regarding the relationship between inflammation and cardiac hormone production in acute cardiac allograft rejection.