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. · Jun 1997
Case ReportsPathologic findings of latissimus dorsi muscle graft in dynamic cardiomyoplasty: clinical implications.
We hypothesize that the integrity of the latissimus dorsi muscle graft used to wrap the heart may affect the clinical outcome of patients undergoing dynamic cardiomyoplasty. ⋯ Our findings are consistent with and support a number of mechanisms proposed for cardiomyoplasty. Thus preservation of latissimus dorsi muscle graft integrity may be important in the success of dynamic cardiomyoplasty.
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J. Heart Lung Transplant. · Jun 1997
Donor blood perfusion improves myocardial recovery after heart transplantation.
Improved methods of donor heart preservation may allow for prolonged storage and permit remote procurement. Previous attempts to use oxygenated perfusion circuits during storage have not gained widespread acceptance because they were either too impractical or complicated to use for remote harvest. We hypothesized that collection and perfusion of donor blood during prolonged storage may improve myocardial recovery. Our aim was to devise a safe, simple, cost-effective system that could be used in any hospital setting. ⋯ Perfusion of donor blood improved the ability to wean off bypass after 4 hours of storage. Blood perfusion permitted persistent myocardial metabolism during the ischemic period, which led to improved functional recovery. Harvesting donor blood for subsequent perfusion during prolonged storage may improve the results of orthotopic heart transplantation and allow for more distant procurement of donor organs.
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In spite of recent reports of the clinical application of single lung transplantation for pulmonary hypertension, there is little underlying experimental data because of the lack of a reliable animal pulmonary hypertensive transplant model. We have established a pulmonary hypertensive model in beagles with dehydromonocrotaline and have been able to measure cardiopulmonary hemodynamics accurately and use circulatory assists during procedures. The purpose of this study was to determine whether single lung transplantation could be performed after the protocol of clinical procedure. ⋯ Thus we were able to show that hemodynamics improved after single lung transplantation with cardiopulmonary bypass in a new pulmonary hypertensive animal model. These relatively larger animals are valuable for further studies of single, double, bilateral, and heart-lung transplantation for pulmonary hypertension.
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J. Heart Lung Transplant. · Apr 1997
Case ReportsExtracorporeal membrane oxygenation for early graft dysfunction in lung transplantation: a case report.
Although extracorporeal membrane oxygenation (ECMO) has become standard treatment for neonatal respiratory failure, the results of ECMO in adults have been less encouraging. With technical improvements in membrane oxygenators and revised ECMO protocols, there has been renewed interest in ECMO for adults with severe acute respiratory failure. ⋯ We present the case of a 20-year-old woman with cystic fibrosis who underwent bilateral single lung transplantation. She had development of severe graft dysfunction in the immediate postoperative period requiring support with ECMO for stabilization.
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J. Heart Lung Transplant. · Apr 1997
Reperfusion injury in single-lung transplant recipients with pulmonary hypertension and emphysema.
The early postoperative course of single-lung transplant recipients depends on the recipient's underlying lung pathophysiology and the degree of ischemic-reperfusion injury. We examined the effect of pulmonary hemodynamics and preoperative diagnosis on early allograft function and the effects of pulmonary hemodynamics, allograft blood flow, and chest radiographs on length of mechanical ventilation and intensive care unit length of stay. ⋯ Elevated allograft blood flow and pressures do not exacerbate radiographically confirmed reperfusion injury. Reperfusion injury is the major cause of early respiratory morbidity after single-lung transplantation. Allograft perfusion in emphysema patients decreases in response to reperfusion injury, but pulmonary hypertension patients remain almost entirely dependent on allograft function, even with severe chest radiograph scores. This may be an important mechanism by which single-lung transplant recipients with emphysema, unlike those with pulmonary hypertension, are able to mitigate the degree of respiratory impairment associated with reperfusion injury.