ABSTRACT
Objective To induce the immune tolerance of heart grafts with infusion of isogeneic bone marrow mesenchymal stem cells (BMSCs) in heart transplant rats.Method Donor Wistar rats and recipient F344 rats were randomly divided into 4 groups:acute rejection group (group A),Wistar rats as the donors and F344 rats as the recipients for heart transplantation; low dose cyclosporin A(CsA) group (group B),recipient F344 rats given low dose CsA; BMSCs group (group C),recipient F344 rats given isogeneic BMSCs; BMSC and low dose CsA group (group D),the recipient F344 rats given isogeneic BMSCs and low dose CsA.The serum cytokine levels were determined,and the donor heart pathological changes and survival were observed postoperatively.The relative level of Foxp3 mRNA expression in the spleen of the recipient F344 rats was also observed.Result The blood levels of interleukin-2 (IL-2) and interferon-γ(INF-γ) were significantly reduced,but IL-4 and IL-10 levels were increased (P＜0.05),and the survival time of donor heart was significantly prolonged in group D as compared with groups A,B and C (P＜0.05 for all).Heart pathological examination revealed a mild acute rejection in group D,moderate acute rejection in groups B and C group,and severe acute rejection in group A respectively.The expression of Foxp3 mRNA was significantly lower in group A than in groups B,C and D (P＜0.05 for all),and that in group D was significantly higher than in groups B and C (P＜0.05 for both),but there was no significant difference between between groups B and C (P＞0.05).Conclusion Intravenous administration of BMSCs can alleviate immunorejection in heterotopic rat heart transplantation.Low-dose CsA acts synergistically with BMSCs to significantly inhibit acute rejection after heart transplantation.The partial mechanisms involve the suppressive effect of BMSCs on the expression of Foxp3 mRNA and modulation on cytokine.
ABSTRACT
Objective To compare the clinical efficacy of BalMedic bovine jugular vein conduit (BalMedic) with homograft in right ventricular outflow tract reconstruction.Methods Totally 10 patients were implanted homograft to reconstruct right ventricular outflow tract,while 14 patients were implanted BalMedic from January 2003 to July 2009,and the function of the implanted conduit was evaluated by Doppler echocardiography one year after operation.Results 9 patients in group Homograft were cured,while 1 patient died of multiple organ failuie caused by infective endocarditis,which was confirmed associated to the conduit.13 patients in group BalMedic were cured,while 1 patient died of heart failure 2 days after operation,which no independent with the conduit.No stenosis of the pulmonary valve and further stoma had been found in both two groups,and they were no significant different( P ＞0.05 ).There were no thrombus aud aneurysm in both two groups.Two patients in group Homograft had low-grade regurgitation with pulmonary valve,while one had middle-grade regurgitation.And 4 patients in group BalMedic had low-grade regurgitation with pulmonary valve,no else became worse.Conclusion Both homograft and BalMedic can be used in reconstruction of right ventricular outflow tract.BalMedic may have better prospect.
ABSTRACT
Objective To evaluate the reconstruction of right ventricle outflow tract (RVOT) with BalMedic pulmonary valved conduit in multiple medical center.Methods Since January 2007,50 patients age (4.90 ± 7.63) years (range 6 month to 39 years),weight (16.20 ± 13.69) kg (range 4.50 to 65.0 kg),had been corrected by reconstruction of RVOT.There were 22 patients with pulmonary atresia and ventricular septal defect (PA/VSD) ; 10 patients with corrected transposition of the great arteries and pulmonary stenosis (C-TGA/PS) ; 7 patients with truncus; 4 patients with double outlet of right ventricle and pulmonary stenosis (DORV/PS) ; 3 patients with tetralogy of Fallot (TOF) ; 2 patients with complete transposition of the great arteries and pulmonary stenosis (TGA/PS) ; and each 1 with aortic stenosis (AS) and pulmonary stenosis (PS).Fifty BalMedic pulmonary valved conduits were implanted between pulmonary and RVOT underwent cardiopulmonary bypass.There were different diameter of pulmonary valved conduit included 10 mm to 24 mm depend on the patients weight and pulmonary size.All patients were followed up after operation on 1 month,3-6 months and more than 12 months.Results There was no death.Three patients were lost followed up after 12 months and one late death.There were no pulmonary valve stenosis about 91.1％,moderate pulmonary regurgitation 16.0％,no RVOT obstruction 95.6％,no main pulmonary artery stenosis 80.0％,and no right and left pulmonary artery stenosis 73.0％.Conclusion These results demonstrated that the BalMedic pulmonary valved conduit is reliable and effective in surgical procedure,but the long-term results should be followed up continually.
ABSTRACT
Objective To retrospectively analyze the clinical management and follow-up of 13 recipients with survival of over ten years after cardiac transplantation. Methods Thirteen male recipients underwent orthotopic heart transplantation between August 1995 and June 2001 in our center and received standard immunosuppressive therapy protocols (8 cases) or induction therapy protocols (5 cases). Cyclosporine, azathioprine or mycophenolate mofetil, and prednisolone were applied as maintenance immunosuppressive regimens. Six recipients switched from azathioprine to mycophenolate mofetil when mycophenolate mofetil was available. Perioperative complications were prevented and treated. After operation, the recipients were followed up regularly to set up personnel long-term follow-up files. The incidence of acute rejection (AR) and (cardiac allograft vasculopathy (CAV) was monitored. Results The 13 survived recipients accounted for 48. 1 % of the total number in the corresponding period (13/27). All survivals recovered well and had a good quality of life. The recent (1 year) complications included acute allograft rejection (3 cases), infection (4 cases), renal insufficiency (3 cases), allograft right ventricular dysfunction (5 cases), post-transplant diabetes (2 cases) and liver dysfunction (5 cases). The long-term (1 year later) complications included acute allograft rejection (2 cases), CAV (2 cases), hypercholesterolemia (5 cases), hypertension (4 cases), hyperuricemia (10 cases) and chronic renal impairment (3 cases). One hepatitis B virus carrier died of liver cancer 13 years after transplantation. Conclusion The long-term survival of cardiac allograft recipients is closely associated with psychological state, financial condition, compliance and follow-up medical system, while the sociological and environmental factors may play important roles.
ABSTRACT
Objective To investigate living quality of patients after orthotopic cardiac transplantation and to provide scientific evidence for specific strategy of therapy and improvement of living quality of patients with cardiac transplantation. Methods SF-36 and the social support questionnaire were used to analyze living quality of 79 patients who received orthotopic cardiac transplantation in the Department of Cardiovascular surgery of Affiliated Union Hospital of Fujian Medical University. The mode of SF-36 was from the investigative numerical value of residents in Sichuan province. Description, t-test and Spearman correlation analysis were used to study the related factors. Results Compared with a reference general population, the heart transplant recipients showed a significantly worse living quality score on all domains of the SF-36 scales (P＜0. 05), except the domain of somatic pain. Among the patients after cardiac transplantation, living quality was more significantly improved in ＞2-year survival group than that in ＜one-year survival group (P＜0. 05),except the domain of somatic pain. The relationships between the social support and living quality were analyzed,and it was found that as compared with a reference general population, the heart transplant recipients showed significantly lower scores on all domains of the social support questionnaire (P＜0. 01 ). The total social support scores were positively related to mental health related living quality (P＜0.05, r = 0.223 - 0.710), except the domain of somatic pain. Conclusion Compared with a general population, heart transplant recipients demonstrated a significantly worsened living quality. But evidence showed the living quality can be improved gradually with the prolongation of the survival time after heart transplantation. Social support was related to the living quality of heart transplantation patients. Improvement of availability on social support will probably improve living quality.
ABSTRACT
OBJECTIVE@#To investigate the effect of cardiomyopeptidin for injection on energy metabolism in isolated hearts of young rats after ischemia-reperfusion injury.@*METHODS@#Fifty young healthy SD rats(aged 20 +/- 3 days and weighing 50-70 g) were randomly divided into 5 groups: a normal control group (NC group, n = 10 ): the isolated hearts were stable for 20 min, and then 150 min continuous perfusion; a normal + cardiomyopeptidin group (NCMP group, n = 10): the same as the normal control group, but K-H buffer solution was added with 50 mg/L cardiomyopeptidin, and 3 ischemia-reperfusion injury model groups, including a model control group (n = 10): the isolated rat hearts were perfused with K-H buffer and then arrested with cardioplegic solution; a CMP1 group (n = 10): the ST.Thomas'II cardioplegic solution was added with 100 mg/L cardiomyopeptidin; CMP2 group (n=10): K-H buffer and ST.Thomas'II cardioplegic solution was added with 50 mg/L and 100 mg/L cardiomyopeptidin respectively. The cardiac functional indexes were monitored, including heart rate, myocardial contractility and diastolic function, peak systolic and diastole myocardial velocities and coronary flow. In the 3 ischemia-reperfusion injury model groups, myocardial ultrastructure was observed through transmission electron microscopy; the creatine kinase isoenzyme (CK-MB) concentration was measured in the fluid outflow of coronary; the content of Na+-K+ ATPase, Ca2+-Mg2+ ATPase, total ATPase, superoxide dismutase (SOD), malondialdehyde (MDA), nitric oxide(NO), total nitric oxide synthase (TNOS), inducible nitric oxide synthase (iNOS) and aldosereductase were measured in the myocardium tissue; the relative expression levels of iNOS, eNOS, and Akr1b4 mRNA in the myocardial tissue were also detected by real-time fluorescence quantitative PCR.@*RESULTS@#In the NC group, after prolonged perfusion, the cardiac function of isolated hearts had no significant change. Cardiomyopeptidin for injection had no significant effect on normal isolated hearts. Compared with the model control group, the cardiac function indexes and coronary flow in the groups treated with cardiomyopeptidin decreased much less. Cardiac myofibrillar fragmentation and mitochondrial swelling were observed in the control group, while in the CMP groups, the myocardial structure was nearly complete, and only mild mitochondria swelling and degeneration could be seen. After the reperfusion, the content of CK-MB was increased in the control group. Compared with the model control group, the CK-MB content was lower in the CMP1 and CMP2 groups. There was a slight decline in the contents of Na+-K+ ATPase, Ca2+-Mg2+ ATPase, and Total ATPase in the CMP1 and CMP2 groups, and an increase in SOD activity (P < 0.01 or P < 0.05). The concentration of NO and MDA produced after the ischemia-reperfusion injury was much lower in the CMP1 and CMP2 groups. The activity of iNOS and aldosereductase was inhibited, the expression levels of iNOS, and Akr1b4 mRNA were significantly down-regulated in the CMP1 and CMP2 groups. These changes were more prominent in the CMP2 group (P < 0.01 or P < 0.05). The eNOS mRNA levels in the CMP2 group was up-regulated (P < 0.05).@*CONCLUSION@#Cardiomyopeptidin for injection may improve the energy metabolism, improve coronary blood flow and cardiac function after the reperfusion, thus protecting immature myocardial against ischemia-reperfusion injury in young rats. Administration of it in both K-H buffer and ST.Thomas'II cardioplegic solution is better than adding it in cardioplegic solution alone. The mechanism may be associated with the inhibition the mRNA expression of iNOS and Akr1b4 in cardiomyocytes, the inhibition activity of iNOS and aldosereductase, and the decrease of NO production.
Subject(s)
Animals , Female , Male , Rats , Aldehyde Reductase , Genetics , Metabolism , Energy Metabolism , In Vitro Techniques , Myocardial Reperfusion Injury , Metabolism , Myocardium , Metabolism , Nitric Oxide , Nitric Oxide Synthase Type II , Genetics , Metabolism , Peptides , Pharmacology , Random Allocation , Rats, Sprague-DawleyABSTRACT
Objective To observe the effect of hepatocyte growth factor on preserving isolated heart of rats. Methods Forty rats were random divided into two groups: Control group(n=20)which rat hearts were isolated and preserved in 4℃HTK solution, and experimental group(n=20)which rat hearts were isolated and preserved in 4℃ HTK+rh-HGF(100μg/L)solution. Before operation and rat hearts were subjected to 8 hours(groupA,C)or 12 hours(group B,D)hypothermic storage followed by 5 minutes of normothermic reperfusion onmodifiedLangendorff-Neely model. The recovery rate of cardiac function after myocardial preservation, such as LVSP and LVDP and±dp/dt max and the changes of CK,LDH,NO and ET were measured. Cell apoptosis was detected by TUNEL staining and the expression of c-met was analyzed by immunohistochemical method. The expression change of bcl-2 mRNA was examined by RT-PCR. Results Compared with control group, experimental group showed that a significantly higher recovery rate of LVSP,LVDP and±dp/dt max(P＜0.01) and lower rate of TUNEL positive cardiomyocytes(P＜0.01) after reperfusion. The leakage of CK and LDH was significant lower than that of control group(P＜0.01). Immunohistochemical analysis revealed that c-met receptor expression was stronger in the HGF-treated myocardium than that in the non HGF-treated myocardium after storage, and this was associated with a stronger expression of bcl-2 mRNA. Conclusion The administration of rh-HGF before storage improved cardiac function after prolonged myocardial preservation by preventing apoptosis and enhancing expression of bcl-2 mRNA. Thus, the addition of rh-HGF in the storage solution may be a promising strategy for prolonged heart graft preservation.
ABSTRACT
Objective To summarize the early effect of orthotopic heart transplantation for 5 patients with end-staged coronary heart disease.Methods Orthotopic heart transplantations were performed on 1 patient with left ventricular mechanic circulatory support for 25 months after twice acute myocardial infarction, 3 patients with failing heart after acute myocardial infarction, 1 patient with failing heart after PTCA and CABG.Results Five patients recovered well. No any severe acute rejection and infection have been found. All survivors had good life quality and good heart function (NYHA I).Conclusion Orthotopic heart transplantation is an effective treatment for patients with end-staged coronary heart disease. Proper donor heart, excellent donor myocardial conservation, suitable immurosuppression treatment and appropriate control of hypertension, hyperglycemia, hypercholesterolemia and uricacidemia are key measures of successful orthotopic heart transplantation for patients with end-staged coronary heart disease.
ABSTRACT
Objective To study the effect of intracoronary adenovirus vector-mediated transforming growth factor ?_1 (Ad.TGF-?_1) gene transfer on discordant cardiac xenograft in the setting of acute vascular rejection. Methods In a cervical heterotopic cardiac transplantation model by cuff technique, after harvest, guinea pig donor hearts’coronary arteries were perfused ex vivo with Stanford University solution containing 5?1010 plaque-forming units/g of donor heart of Ad.TGF-?_1, then implanted in the necks of complement depleted and immunosuppressed rat recipients. As controls, other hearts were perfused with Stanford University solution containing 5?1010 plaque-forming units/g of donor heart adenoviral blank-vector or with virus-free Stanford University solution by the same method.Results The exogenous TGF-?_1 gene transcripts and expression in the Ad.TGF-?_1 infected grafts were confirmed. The number of inflammatory cells and macrophages and nature killer cell infiltration in the cardiac xenografts of Ad.TGF-?_1 infected grafts was less than that of other groups (P
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the rehabilitation of the sexual function of male patients after heart transplantation.</p><p><b>METHODS</b>Eleven discharged adult male cardiac transplant recipients (ranging 32-54 years) with a normally functioning allograft for at least 9 months were questioned on their pre- and post-operative sexual function.</p><p><b>RESULTS</b>All the recipients complained of a significant pretransplantive decrease and 10 stated a significant posttransplantive increase in sexual function.</p><p><b>CONCLUSION</b>The sexual function of the male recipients was significantly improved after cardiac transplantation. Psychosocial factors affecting the rehabilitation of sexual function should not be neglected.</p>
Subject(s)
Adult , Humans , Male , Middle Aged , Heart Transplantation , Psychology , Sexual Behavior , Transplantation, HomologousABSTRACT
Objective To investigate plasma homocystein (Hcy) level in cardiac transplant patients.Methods Fourteen cases of heart transplant patients were recruited in this study. Plasma Hcy levels were measured by using high-performance liquid chromatography with fluorescence detection and flow-mediated dilatation in brachial arteries detected with high-resolution ultrasound in all patients, while coronary artery angiography were performed in 7 patients.Results In 2 cases of heart transplant who had single coronary artery stenosis, the plasma Hcy levels were above 12 ?mol/L. The average plasma Hcy levels in heart transplant patients were higher than in health volunteers [( 13.47? 2.78) ?mol/L vs (9.26? 3.57) ?mol/L], and flow-mediated dilatation in brachial arteries of heart transplant patients was lower than that of health volunteers [( 8.2? 3.7) % vs ( 12.5? 1.6) %]. There was a linear correlation between levels of plasma Hcy and flow-mediated dilatation (r= -0.804). Conclusion Endothelial dysfunction in the heart transplant patents might be contributed to hyperhomocysteinemia which may be potential cause of transplant coronary artery disease.
ABSTRACT
Objective To study the effects of intracoronary transfer of adenovirus vector-mediated transforming growth factor ?_1 gene on acute rejection of cardiac allograft in rats. Methods In a cervical heterotopic cardiac transplantation model, donor hearts coronary arteries were perfused ex vivo after harvest with Stanford University solution containing 5?10~ 10 plaque-forming units/gram of donor heart of donor heart of Ad. TGF-?_1, then implanted in the necks of recipients. As controls, other hearts were perfused with Stanford University solution containing 5?10~ 10 plaque-forming units/gram of donor heart adenoviral bland-vector or with virus-free Stanford University solution by the same method. Results The exogenous TGF-?_1 gene transcripts and expression in the Ad.TGF-?_1 infected grafts were confirmed. The expression of CD_ 68 and the apoptosis index in the cardiac allografts of Ad. TGF-?_1 group were less than that of other two groups (P
ABSTRACT
AIM: The aim of this study was to investigate the hemodynamic characteristics of the denervated orthotopic transplanted hearts. METHODS: Eighteen patients with end - stage cardiopathy underwent orthotopic cardiac transplantation received immunosuppressive induction therapy. The changes of hemodynamics were closely monitored during the perioperative period and the periodic check-up of echocardiogram and electrocardiograph were followed up in the postoperative long-term period. RESULTS: All recipients were received vasoactive drug and active diuretic therapy during the perioperative period. An increase in central venous pressure in concomitance with decrease in cardiac output, cardiac index and mixed venous oxygen saturation within 24 to 48 hours and tend to stable 48 hours postoperation were detected. In the follow - up period, the cardiac functions of allografts were all recovered well. No recipient complained angina pectoris. CONCLUSIONS: The hemodynamic characteristics and clinical pharmacological therapeutic implications of cardiac denervation are very unique. Rational application of inotropic support and diuretic therapy and vasodilatation combined with prudent administration of some agents, which affect the physiology of denervated heart, are the most effective measures for the prevention of postoperative complications of cardiac allograft.
ABSTRACT
Orthotopic heart transplantation was performed on two critical patients with end-stage dilated cardiomyopathy on Oct.14, 1996 and March 20, 1997 respectively.One case of pre-operative hepatic-renal failure died of systemic organs failure and severe circulation failure in oper-ation, and the other case of severe pulmonary hypertension preoperatively died of right heart fail-ure and pulmonary hypertension crisis on the seventh day after operation.Operating time and indi-cations of heart transplantation, preoperative evaluation for the patients with pulmonary hyperten-sion, and management of right heart failure after heart transplantation were detailedly discussed.
ABSTRACT
Kaneko's rahbit heart-lung transplant model was used xo investigate the effect of low flow perfusion(LFP)on rabbit heart-lung preservation.Thirty-two healthy rabbits were randomly divided into control group and experimental group.The donors in the experimental group were continuously perfused via aorta and pulmonary artery at low flow rate with the same perfusates during preservation.After heart-lung transplanted, the donors' LVsp, LVedp, RAP and Paw, and PaO2 were measured every 30 min for 90 min to evaluate the function of heart and lung.After finishing the trial, the contents of MDA in heart and lung were determined and the water weight gain calculated.The results showed that the rabbits in the experimental group had a significantly lower water weight gain and better cardiac and pulmonary function than in the control group.The experimental group produced less levels of MDA in heart and lung than did the control group.It is concluded that LFP is more effective than cold storage on rabbit heart-lung preservation.
ABSTRACT
Orthotopic heart transplantation was successfully performed on one patients with endstage dilated cardiomyopathy.The patient has been survived for more than 1 year until today and is now living well.The immunosuppressive therapy and the acute rejective surveillance for 1 year after operation were detailedly introduced and discussed in this paper.In the second week and sixteenth week after operation,two episodes of acute cardiac rejection occurred and were promptly treated well with methylprednisolone.
ABSTRACT
Objective To observe cardiac structural and functional alterations one year following orthotopic heart transplantation. Methods In 23 patients with orthotopic heart transplantation, the end-diastolic diameter of the atria and the ventricles(LAD, RAD, LVEDD and RVED), the thickness of interventricular septum,left ventricular posterior wall and right ventricular anterior wall(IVS,LVPW and RVAW),and pericardial effusion(PE) were measured by M- and B-mode echocardiography, ventricular early and late diastolic filling peak velocities(E, A and E/A) and systolic peak pulmonary artery pressure(PAP) were assessed by Doppler techniques. Results PAP, RAD and RVED increased at 2 week following heart transplantation and gradually returned normal at one month. At 1-2 month after operation, IVS, LVPW and RVAW increased, and E decreased with a reversed E/A. PE was detected in moderate amount at 1-2 week, in small amount at 1-3 month, and disappeared at 6 month following the transplantation. Conclusions The structures and functions of the transplanted heart undergo serially adaptive changes postoperatively, and evaluation of these alterations echocardiographically may be helpful to identifying allograft rejection.
ABSTRACT
AIM and METHODS: To investigate the cardioprotective effect of adenosine infusion before ischemic preconditioning on immature myocardial reperfusion injury in rabbit heart. Isolated perfused working heart model were performed, all hearts were subjected to 2-hour global hypothermic ischemia and received intermittent cold cardioplegia perfusion. RESULTS:During reperfusion, the recovery of left ventricular systolic pressure, left ventricular end-diastolic pressure, +d p /d t max, and -d p /d t max of hearts received adenosine infusion before ischemic preconditioning were significantly improved, myocardial adenosine triphosphate and adenosine diphosphate content and superoxide dismutase activity were higher, the leakage of myocardial creatine kinase and the malondialdehyde content were lower, and myocardial water content was obviously less. CONCLUSION: These results suggest adenosine infusion before ischemic preconditioning enhances cardioprotection of ischemic preconditioning against immature myocardial reperfusion injury in the rabbit heart.