Outcome post orthotopic heart transplantation for patients with end-stage hypertrophic cardiomyopathy / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the outcome of orthotopic heart transplantation for patient with end-stage hypertrophic cardiomyopathy.</p><p><b>METHODS</b>This retrospective review analyzed the clinical data of nine patients (7 males) undergoing orthotopic heart transplantation for end-stage hypertrophic cardiomyopathy in our center. All patients received induced therapy protocols peri-operative and standard triple maintenance immunosuppressive therapy postoperative.</p><p><b>RESULTS</b>One recipients developed acute renal failure due to renal artery embolism and allograft rejection in the early posttransplantive course, symptoms and signs were improved under continuous renal replacement therapy and steroid-pulse therapy, this patient died of sudden cardiac arrest at 32 months post transplantation. Another recipient developed demyelinating disease in frontal and parietal lobe and finally recovered with medical therapy. Eight patients survived the operation with good quality of life and there was no episode of rejection or infection or chronic graft arteriosclerosis during follow-up time. Three recipients developed left ventricular hypertrophy and there were no signs of grapg-vessel diseases in the survivals.</p><p><b>CONCLUSION</b>Heart transplantation is the best therapeutic option for selected patients with end-stage hypertrophic cardiomyopathy.</p>

Mid- and long-term acute cardiac allograft rejection: clinical observation of 14 patients / 南方医科大学学报

<p><b>OBJECTIVE</b>To analyze the clinical features of mid- and long-term acute cardiac allograft rejection to improve the long-term clinical outcomes of the patients.</p><p><b>METHODS</b>Fourteen recipients (11 males and 3 females) underwent orthotopic heart transplantation with standard immunosuppressive therapy protocols (3 cases) or induction therapy protocols (11 cases). Cyclosporine, azathioprine or mycophenolate mofetil, and prednisolone were applied as the maintenance immunosuppressive regimen. Acute graft rejection episodes occurred within 3 to 6 months in 1 case, within 6 months to 1 year in 3 cases, within 1 to 2 years in 3 cases, within 2 to 5 years in 6 cases, and above 5 years in 1 case.</p><p><b>RESULTS</b>No significant difference was found in the incidence of late heart rejection between the patients receiving the two immunosuppressive therapy protocols. Immunosuppressants were withdrawn or spared in 8 recipients due to different causes. Nine recipients with steroid-sensitive acute cardiac allograft rejection were treated with steroid-pulse therapy, while the other 5 were treated with a short course of polyclonal antithymocyte antibodies because of steroid-resistant acute rejection; in 11 cases, azathioprine was converted to mycophenolate mofetil. Four of the 5 late deaths occurred in the recipients with steroid-resistant rejection. The surviving recipients had a good quality of life, and no recurrent episodes of rejection or infection were observed in the follow-up period.</p><p><b>CONCLUSIONS</b>Late acute cardiac allograft rejection is associated mainly with patient compliance but not with early immunosuppressive therapy protocols. The episodes are rather severe and should be timely treated with steroid pulses or polyclonal antithymocyte antibodies.</p>

Individual immunosuppressive regime in heart transplantation with high risk / 中华外科杂志

<p><b>OBJECTIVE</b>To Summarize the clinical experience of individual immunosuppressive regime in heart transplantation with high risk.</p><p><b>METHODS</b>From September 2001 to December 2006, 51 cases with the complication of Hepatitis B viruses (HBV) infection, diabetes mellitus, renal dysfunction or pulmonary infection in perioperative period were analyzed retrospectively. All cases received daclizumab (Zenapax) induction therapy, and baseline triple immunosuppressive regime was consist of cyclosporine (CsA), azathioprine (Aza) or mycophenolate mofetil (MMF) and prednisone (Pred). Ten cases received HBV infection in preoperative period, the immunosuppressive protocol was emphasized on the use of MMF and the withdraw of Pred one month later in postoperation. Nine cases received diabetes mellitus in pre-operation, 4 cases had post-transplant diabetes mellitus. The immunosuppressive protocol was emphasized on the use of CsA rather than FK506, the use of Pred was less dosage, and the therapy of insulin was necessary. Sixteen cases had renal dysfunction in pre-operation, the use of MMF was routine but the use of CsA was delayed to the time 5 to 19 d postoperative. Twelve cases received pulmonary infection after allograft transplantation. The immunosuppressive agent was to be taped or suspended in therapy time.</p><p><b>RESULTS</b>The liver function of the 10 cases with HBV infection was stable in 1 year follow-up, and 1 case received acute rejection after 13 months allograft transplantation. In the 6 months follow-up, the blood glucose level of the 13 cases with diabetes mellitus was stable, none of the cases suffered from acute rejection. In the one month follow-up, none of the 16 cases with renal dysfunction suffered from acute rejection, and the renal function was normal. Two of the 12 cases with the pulmonary infection were died of serious infection, others were survival. One case received acute rejection on the 17th day in postoperation.</p><p><b>CONCLUSIONS</b>Low mortality can be realized by selecting appropriately individual immunosuppressive regime and the episode of acute rejection is rare.</p>

Analysis of surgical treatment for Standford type A aortic dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the surgical experience of type A aortic dissection.</p><p><b>METHODS</b>From January 2001 to December 2006, 54 cases were admitted for Standford type A aortic dissection, including 36 cases of acute aortic dissection and 18 cases of chronic. Thirty-five cases underwent emergence operation and 11 cases underwent selective/limited operation, while 8 cases received medical treatment According to the modus operandi of root of aorta, 9 cases underwent ascending aorta replacement merely, 11 cases for Bentall operation, 12 cases for Wheat operation and ascending aorta replacement, 14 cases for David operation and ascending aorta replacement. According to the modus operandi of aortic arch and descendens, 6 cases underwent right hemiarch replacement, 25 cases for total arch replacement with four branches aortic graft, 24 cases for stent-graft elephant trunk technique. One patient of coronary heart disease and 1 patient of right coronary fracture underwent coronary artery bypass grafting. Deep hyperthermic circulatory arrest and antegrade selective cerebral perfusion were applied with aortic arch operation. Surface cooling was applied with selective/limited operation.</p><p><b>RESULTS</b>Four patients died in operation group (8.7%) and 8 died in non-operation group (75.0%). Postoperative complication included 1 mental symptom, 3 pleural/pericardial effusion, 1 hoarseness, 1 sternal rupture and poor wound healing. All the complication were cured. The operative out-hospital patients were followed up (13.0 +/- 14.2) months and the quality of life was satisfied.</p><p><b>CONCLUSIONS</b>Standford type A aortic dissection should be operated aggressively. Expected outcome could be acquired with optimum modus operandi, proper cerebral protection and dealing with postoperative complication timely.</p>

Early outcome of orthotopic heart transplantation: a report of 21 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To report the preliminary experience of 21 orthotopic heart transplantations without early death.</p><p><b>METHODS</b>Between April 2002 and June 2005, 21 patients underwent orthotopic heart transplantation. Recipients' pulmonary vascular resistance ranged from 3.0 to 5.9 wood units [mean (4.3 +/- 1.4) wood units]; Stanford myocardial protective solution or HTK solution was perfused for donor heart myocardial preservation, donor heart cold ischemic period ranged from 52 to 310 min [mean (81 +/- 23) min]; Three patients had previous cardiac operations under cardiopulmonary bypass, conventional Stanford orthotopic cardiac transplantation in 20 cases and total heart technique in 1 case; Recipients received simulect preoperatively and cyclosporine A, cellcept and prednisone postoperatively for prevention of acute allograft rejection; Patients received appropriate medical control of hypertension, hyperglycemia, hypercholesterolemia and uricacidemia.</p><p><b>RESULTS</b>Acute right heart failure in 3 cases and pericardial effusion in 4 cases were observed at the early postoperative stage, but no any infection and acute rejection were found. All patients survived with good life quality.</p><p><b>CONCLUSIONS</b>Heart transplantation may produce satisfying early results. Suitable selection of recipients with low pulmonary vascular resistance, excellent donor heart conservation, practised anastomotic technique, proper immunosuppression treatment and efficient postoperative management are key measures of orthotopic heart transplantation with excellent early outcome.</p>

Effect of Ginkgo biloba extract preconditioning on discordant cardiac xenografts / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To investigate the effect of ginkgo biloba extract (ginaton) preconditioning on discordant cardiac xenografts from guinea pig to rat, and explore its mechanism.</p><p><b>METHODS</b>Cervical cardiac transplantation model was established in the rats,which were divided into 4 groups Group 1 (cobra venom factor ( CVF) pretreatment, n = 10]; Group 2 (CVF + ginaton, n = 5) ; Group 3 Ccyclosporine (CsA); Group 4 (CVF + CsA + ginaton, n = 8]. The survival time and histopathology after xenograft were observed and expressions of intercellular adhesion molecule-1 (ICAM-1) heme oxygenase-1 (HO-1) CD68 and CD57 were detected.</p><p><b>RESULTS</b>Pathologic manifestion of grafts showed changes of acute vascular rejection (AVR) in all groups. The mean survival time after car diac xenograft was 41 hrs in Group 1, 68 hrs in Group 2, 55 hrs in Group 3 and 74 hrs in Group 4. Expression of intercellular adhesion molecule-1 (ICAM-1 ) decreased after ginaton preconditioning (P < 0. 05). CD68 and CD57 expressions were down-regulated, HO-1 expression was up-regulated, as well as the apoptotic index (Al) reduced significantly after ginaton with cyclosporine A preconditioning.</p><p><b>CONCLUSION</b>Ginaton preconditioning can prolong the survival time after discordant xenograft, and significantly alleviate pathological lesion from acute xenograft vascular rejection combined with cyclosporine A.</p>

Effect of tetramethylpyrazine on endothelin, von Willebrand factor and thromboxane A2 during cardiopulmonary bypass in patients of congenital heart disease with pulmonary hypertension / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To study the effect of tetramethylpyrazine (TMP) on the vascular endothelial cell (VEC) related humoral factors, including endothelin (ET), factor VIII related antigen (i.e. von Willebrand factor, vWF) and thromboxane A2(TXA2) in patients of congenital heart disease with pulmonary hypertension (CHD-PH) during cardiopulmonary bypass (CPB), and explore the clinical physiopathologic significance of them.</p><p><b>METHODS</b>Thirty non-cyanotic patients of CHD-PH were randomly divided into the control group and the treated group. TMP was given to the treated group by intravenous dripping 3 mg/kg after anesthesia induction and adding 1 mg/kg in oxygenator during CPB. Blood samples were collected from radial artery at the time points of after anesthesia induction, 15 min after beginning CPB, 5 min after opening aorta, 20 min, 6 hrs and 24 hrs after stopping CPB, to determine the plasma contents of ET and vWF, as well as TXB2, the stable metabolite of TXA2. The pulmonary vascular reactivity 6 hrs (6h-PVR) after CPB and the mechanical ventilatory support time (VST) after operation were calculated.</p><p><b>RESULTS</b>Levels of ET, vWF and TXB2 increased obviously during CPB, but the degree of increasing in the treated group was lower than that in the control group (P < 0.05), and the 6h-PVR and VST in the former were also lower than those in the latter respectively.</p><p><b>CONCLUSION</b>TMP could obviously reduce the production of ET, vWF and TXB2 during CPB and relieve the pulmonary vascular reactivity after operation, indicating that TMP could reduce the injury of CPB on VEC, and is benefit to enhance the efficacy of treatment.</p>