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. · May 1993
Case ReportsCardiac allograft harvesting after carbon monoxide poisoning. Report of a successful orthotopic heart transplantation.
Hearts from brain dead victims of carbon monoxide poisoning have been reported to be unsuitable for heart transplantation. We present the case of a 30-year-old male donor who was the victim of carbon monoxide poisoning. He was on ventilation for 16 days before the organs were offered for harvesting. ⋯ Heart transplantation was performed successfully. No evidence of ischemic areas or myocardial cell necrosis could be found in all heart biopsy specimens. Four months after transplantation, graft function remains excellent.
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J. Heart Lung Transplant. · Mar 1993
Reliable noninvasive rejection diagnosis after heart transplantation in childhood.
Rejection diagnosis was exclusively handled with noninvasive techniques in 16 children (mean age, 8.6 +/- 5.7 years; range, 0.9 to 15.2 years) over a total follow-up period of 18.3 patient years. No endomyocardial biopsies were performed. Intramyocardial electrogram recordings and echocardiographic investigations were used as two noninvasive techniques for rejection diagnosis. ⋯ Daily monitoring of QRS amplitude in patients at home is an excellent safeguard against overlooking significant rejection episodes. This is of special importance in infants and children, in whom routine endomyocardial biopsy cannot be performed. Distant overnight monitoring minimizes psychosocial disturbance during follow-up after heart transplantation.
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J. Heart Lung Transplant. · Mar 1993
Comparative StudyPulmonary vasodilation after heart transplantation. A comparison among prostacyclin, sodium nitroprusside, and nitroglycerin on right ventricular function and pulmonary selectivity.
The aim of this study was to compare the effects of prostacyclin on central hemodynamics and right ventricular function to the more widely used vasodilators, sodium nitroprusside and nitroglycerin, and to investigate whether prostacyclin is more selective to the pulmonary vascular bed compared to sodium nitroprusside and nitroglycerin in patients after heart transplantation. Hemodynamic measurements were made after the operation in the intensive care unit with a pulmonary artery fast-response ejection fraction/volumetric thermodilution catheter. The aim was to maintain mean arterial pressure around 70 mm Hg with each drug. ⋯ Systemic vascular resistance was lowest for prostacyclin compared to both sodium nitroprusside and nitroglycerin. The pulmonary vascular resistance/systemic vascular resistance ratio used as an index of pulmonary selectivity did not differ between the vasodilators. The right ventricular ejection fraction did not differ among the three drugs.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Heart Lung Transplant. · Jan 1993
Effects of triiodothyronine and vasopressin on cardiac function and myocardial blood flow after brain death.
Previous studies have documented decreases in serum-free triiodothyronine (T3) after brain death and improved hemodynamics with its replacement, suggesting its controversial, but promising, clinical utility for managing potential organ donors. Vasopressin is also commonly used clinically as a pressor agent after brain death. A load-independent analysis of cardiac function and an assessment of myocardial blood flow (MBF) with these agents have not been reported, however. ⋯ Analysis of endocardial to epicardial flow ratios disclosed no significant differences between groups at any time. In summary, animals treated with T3 had a greater decline in MBF than the control group at 4 hours, without any benefit to cardiac function. Further studies examining the mechanism responsible for the deterioration of MBF and cardiac dysfunction will be necessary to optimally manage the brain dead patient before organ harvest, especially regarding the precise role of T3.
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J. Heart Lung Transplant. · Jan 1993
Antibody formation after drug administration during cardiac surgery: parameters for aprotinin use.
Patients who require cardiac surgery or heart-lung transplantation may have been previously sensitized to drugs and blood products to which they may be reexposed during their current surgery. Reexposure may produce an anaphylactic reaction, a life-threatening allergic response. The presence of immunospecific immunoglobulin (Ig)E antibodies and, perhaps, certain classes of IgG antibodies may increase the risk of anaphylaxis. ⋯ The risk of anaphylaxis after protamine administration is much higher among neutral protamine Hagedorn insulin-dependent diabetic patients (0.6% to 2%) than among non-neutral protamine Hagedorn insulin-dependent diabetic patients (0.06%). However, patients with pulmonary hypertension or prior exposure to protamine from previous cardiac surgery were not at an increased risk for anaphylaxis after protamine exposure. The presence of preexisting IgE antibodies has been shown to be highly predictive of the development of anaphylaxis.(ABSTRACT TRUNCATED AT 250 WORDS)