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. · Aug 2001
Comparative StudyPulmonary artery systolic pressures estimated by echocardiogram vs cardiac catheterization in patients awaiting lung transplantation.
At many lung transplant centers, right heart catheterization and transthoracic echocardiogram are part of the routine pre-transplant evaluation to measure pulmonary pressures. Because decisions regarding single vs bilateral lung transplant procedures and the need for cardiopulmonary bypass are often made based on pulmonary artery systolic pressures, we sought to examine the relationship between estimated and measured pulmonary artery systolic pressures using echocardiogram and catheterization, respectively. ⋯ In patients with pulmonary hypertension awaiting transplant, pulmonary artery systolic pressures estimated by echocardiogram correspond but do not serve as an accurate predictive model of pulmonary artery systolic pressures measured by catheterization. Technical limitations of the echocardiogram in this patient population often preclude estimating pulmonary artery systolic pressure.
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J. Heart Lung Transplant. · Jul 2001
Case ReportsNocardia asteroides abscess after heart transplantation.
We describe a patient who developed a primary, thigh adductor-muscle abscess caused by Nocardia asteroides 3 years after orthotopic cardiac transplantation. Nocardia was diagnosed by microbiologic culture and responded fully to a prolonged course of cotrimoxazole. The patient remains free of local or systemic disease at 2 years follow-up.
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J. Heart Lung Transplant. · Jul 2001
Hypotensive reactions associated with transfusion of bedside leukocyte-reduction filtered blood products in heart transplanted patients.
Severe hypotensive reactions that occur during transfusions of blood products to non-transplanted patients were recently linked to the use of bedside leukocyte-reduction filters, sometimes in association with angiotensin-converting enzyme (ACE) inhibitor treatment. We present the first report of such reactions in patients who underwent orthotopic heart transplantation. Fourteen (47%) of the 30 transfused patients experienced severe hypotensive reaction during filtered transfusion of at least 1 unit of blood product, with a total of 24 episodes. Eleven (79%) of these patients were treated pre-operatively with ACE inhibitors.
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J. Heart Lung Transplant. · Jun 2001
Early intervention after severe oxygenation index elevation improves survival following lung transplantation.
Reperfusion injury and technical problems following lung transplantation may result in life-threatening pulmonary dysfunction that requires intervention with either extracorporeal membrane oxygenation or reoperation. Early intervention in these patients could prevent complications associated with delayed or emergent intervention and may improve survival. The oxygenation index [(mean airway pressure x percent of inspired oxygen)/partial pressure of arterial oxygen] provides a rapid assessment of pulmonary function in the critical phase of reperfusion. Our hypothesis was that the oxygenation index could be used as an early predictor for severe respiratory failure requiring acute intervention. ⋯ Oxygenation index elevation > or = 30 following lung transplantation is an early predictor of severe respiratory failure requiring acute intervention. Early intervention in these patients improves survival.
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J. Heart Lung Transplant. · May 2001
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialTacrolimus versus cyclosporine after lung transplantation: a prospective, open, randomized two-center trial comparing two different immunosuppressive protocols.
The need for better immunosuppressive protocols after lung transplantation led us to investigate tacrolimus (Tac) in combination with mycophenolate mofetil (MMF) and steroids or cyclosporine (CsA) in combination with MMF and steroids in a prospective, open, randomized trial after lung transplantation. ⋯ The combination of Tac and MMF seems to have slightly higher immunosuppressive potential compared with CsA and MMF. The effectiveness of Tac as a rescue agent is not paralleled with undue signs of overimmunosuppression.