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 2009
Case ReportsSuccessful up-front combination therapy in a patient with idiopathic pulmonary hypertension and patent foramen ovale: an alternative to epoprostenol therapy?
Pulmonary arterial hypertension (PAH) is a life-threatening disease of the pulmonary arterioles, which, in the absence of effective therapy, progresses rapidly to right heart failure and death. Opening of a patent foramen ovale (PFO) is common in patients with severe pulmonary hypertension (PH), resulting in resistive hypoxemia. We report the case of a 40-year-old woman with idiopathic pulmonary hypertension (iPAH) in New York Heart Association (NYHA) class III to IV, who was admitted in the intensive care unit with hemodynamic compromise and severe hypoxemia due to right-to-left shunt throughout a PFO. Combination therapy initially with inhaled iloprost and sildenafil, and then addition of an endothelin A receptor-selective antagonist (sitaxsentan), resulted in impressive improvement in oxygenation with reversal of the right-to-left shunt and marked improvement in functional class of the patient.
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J. Heart Lung Transplant. · Jun 2009
Clinical TrialNeurocognitive assessments in advanced heart failure patients receiving continuous-flow left ventricular assist devices.
Neurocognitive (NC) changes in heart failure patients receiving left ventricular assist devices (LVADs) are not well understood. The purpose of this study was to document changes in the cognitive performance of patients with the continuous-flow HeartMate II LVAD as a bridge to transplant (BTT). ⋯ The cognitive performance of advanced heart failure patients remained stable or showed slight improvements from Month 1 to Month 6 of continuous-blood-flow support with the HeartMate II LVAD.
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J. Heart Lung Transplant. · May 2009
Prognostic value of bronchoalveolar lavage neutrophilia in stable lung transplant recipients.
Bronchoalveolar lavage (BAL) neutrophilia may identify patients prone to develop bronchiolitis obliterans syndrome (BOS) after lung transplantation (LTx). This study assessed the predictive value of BAL neutrophilia in stable recipients. ⋯ BAL neutrophilia in stable recipients is of predictive value to identify recipients at risk for BOS. These data warrant prospective confirmation and further studies to evaluate the benefit of preemptive therapy for potential BOS patients.
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J. Heart Lung Transplant. · May 2009
Relationship of hormonal resuscitation therapy and central venous pressure on increasing organs for transplant.
Hormonal resuscitation therapy (HRT) has been shown to increase the number of organs available for transplant. Likewise, optimal fluid balance, as measured by central venous pressure (CVP), impacts the function of donor lungs. The purpose of this study is to examine the interplay of these two variables in donor management and the impact they have on organs transplanted, with particular emphasis on hearts and lungs. ⋯ Standardization of HRT, in combination with a CVP <10 mm Hg, significantly increases the utilization of hearts and lungs for transplantation, without negatively impacting other organ systems.
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J. Heart Lung Transplant. · May 2009
Levosimendan: a new therapeutic option in the treatment of primary graft dysfunction after heart transplantation.
Primary graft dysfunction after heart transplantation is a severe complication generally related to prolonged ischemia time, size mismatch, or poor quality of the organ. Current therapeutic options include pharmacologic inotropic support with catecholamines or phosphodiesterase inhibitors, and mechanical circulatory support. ⋯ The patients showed a rapid reduction of the doses of inotropic drugs, and no patient needed mechanical support. Levosimendan may be a useful, adjunctive inotropic drug in the treatment of patients with primary graft dysfunction after heart transplantation.