Outcome of the first successful heart-lung transplantation in the Baltic countries.

Successful heart-lung complex transplantation was performed in a 48-year-old man. During the postoperative period, M. tuberculosis infection was diagnosed, and the treatment subsequently started. One year after, the patient was urgently hospitalized due to myocardial infarction. However, despite the best efforts, the patient died. Antituberculosis treatment is recommended to all the patients with confirmed active tuberculosis. Treatment of tuberculosis in transplant recipients is similar to that of the general population, with the exclusion of rifamycins in the regimen and longer duration of treatment.

Matrix metalloproteinase-3 gene polymorphism and dilatative pathology of ascending thoracic aorta.

Matrix metalloproteinase-3 (MMP-3) degrades extracellular matrix and may lead to development of dilatative pathology of ascending thoracic aorta. Expression of MMP-3 depends upon the 5A/6A polymorphism in the promoter region. An increased number of 5A alleles leads to high expression of MMP-3. Thus, objective of the study was to determine whether the 5A/6A polymorphism in the promoter region of MMP-3 gene is associated with the development of dilatative pathology of ascending thoracic aorta. We studied 76 patients (age ranged from 31 to 81 years; median age, 64 years) who underwent aortic reconstruction surgery due to dilatative pathology of ascending thoracic aorta and a random sample of the population (n=604) aged 25-64 years, all from Lithuania. DNA was analyzed by using real-time polymerase chain reaction to genotype polymorphism 5A/6A at a position -1171 of the MMP3 gene promoter. The prevalence of MMP-3 genotypes was similar in the group of dilatative pathology of ascending thoracic aorta and random sample of population. The frequency of 5A allele did not differ significantly between both groups and was 0.506 and 0.514, respectively. Male carriers of 5A/5A genotype were significantly younger compared with those with the 6A/6A genotype. In conclusion, the frequency of MMP-3 promoter 5A/6A genotypes did not differ between the group of patients with dilatative pathology of ascending thoracic aorta and the random sample of population, but the males with dilatative pathology of ascending thoracic aorta and 5A/5A genotype required aortic reconstruction surgery at the younger age than the males carrying 6A/6A genotype in the MMP-3 promoter region.

Lung edema formation during cold perfusion: important differences between rat and porcine lung.

BACKGROUND: The aim of this study was to investigate the effect of different perfusion pressures on edema formation during cold flush perfusion with the 2 most commonly used preservation solutions in clinical lung transplantation: Euro-Collins and Perfadex solutions. METHODS: Isolated rat and porcine lungs were perfused for 3 minutes at 4 degrees C to 8 degrees C at a pressure of either 10, 15 or 20 mm Hg. Weight gain was recorded continuously. Weight gain per minute was calculated after the first phase of rapid weight gain was completed. RESULTS: In the rat model, perfusion pressure of 10 mm Hg resulted in a macro- and microscopically apparent edema, irrespective of the type of preservation solution. Perfusion pressures of 10, 15 and 20 mm Hg have weight gains of 100%, 150% and 350%, respectively, after 3 minutes of perfusion. The corresponding weight gain per minute was 18%, 31% and 84% of the initial weight. There were no statistically significant differences in weight gain between the different solutions at equal perfusion pressure. In the porcine model the flow was extremely low at 10 mm Hg and no weight gain was registered, whereas the weight gain per minute at 15 and 20 mm Hg was 1.0% and 2.1% of the initial weight. CONCLUSIONS: In porcine lungs, cold perfusion at 20 mm Hg gives minimal edema formulation, whereas in rat lungs the edema formation is deleterious, irrespective of the solution used.

The influence of cardiopulmonary bypass on respiratory dysfunction in early postoperative period.

BACKGROUND AND OBJECTIVE: Pulmonary dysfunction is one of the most serious problems in an early postoperative period after cardiac surgery. This study was designed to reveal the impact of performed cardiopulmonary bypass on pulmonary function during early postoperative period by evaluating the intrapulmonary shunt. MATERIAL AND METHODS: Twenty-one patients undergoing elective myocardial revascularization surgery were analyzed. The patients were divided into two groups. Group 1 included 11 patients who underwent cardiac surgery on cardiopulmonary bypass. Group 2 included 10 patients who underwent cardiac surgery without cardiopulmonary bypass. Preoperative data were similar in the both groups. Blood gas analysis for intrapulmonary shunt calculations was made at 20 minutes after the induction of anesthesia and at 4 hours after the surgery. Intrapulmonary shunt size (Qs/Qt) was also calculated and the records were studied for additional data. RESULTS: At 4 hours after surgery Qs/Qt increased, compared to the preoperative data in Group 1 (from 8.6+/-2.1 to 16.8+/-2.6%, p<0.02). Intrapulmonary shunt was great in Group 1 compared with Group 2 at four hours after the surgery (16.8+/-2.6 and 7.8+/-2.1%, p<0.02). In Group 1 80 % of alterations in a pulmonary function were caused by atelectasis, detected by chest X-ray. In Group 2 no increase in intrapulmonary shunt and no atelectasis were determined. CONCLUSIONS: Arterial hypoxemia and increase in intrapulmonary shunt (due to atelectasis) have proven that alterations in pulmonary function are found more often and are more pronounced in patients after surgery on cardiopulmonary bypass.

Transplantation of lungs from non-heart-beating donors after functional assessment ex vivo.

BACKGROUND: If lungs from patients dying of heart attacks are to serve as donor organs in a safe way, their function should be properly assessed before transplantation. The aim of this study was to investigate donor lung function evaluation in a realistic large animal model. METHODS: Twelve 60-kg pigs were used. Five minutes after ventricular fibrillation was induced, cardiopulmonary resuscitation was initiated and maintained for 20 minutes. After a 10-min hands-off period, heparin was administered through a central venous catheter followed by 20 chest compressions. Intrapleural cooling was initiated after 65 minutes of warm ischemia. Cooling proceeded for 6 hours within the cadaver, after which lung function was assessed ex vivo. Recipient pigs underwent left lung transplantation followed by right pneumonectomy, thus making these animals 100% dependent for their survival on the function of the donor lungs. RESULTS: The assessment showed that all lungs had adequate function to serve as donor lungs. All recipient animals were in good condition during the 24-hour observation period after the operation. The blood gas function did not differ significantly from that in the healthy donor animals before induction of ventricular fibrillation; pulmonary vascular resistance was within normal range. CONCLUSIONS: Lungs from non-heart-beating donors topically cooled in situ for 6 hours after 65 minutes of warm ischemia were assessed ex vivo and found to have normal function. They were then transplanted and retained normal function during a 24-hour observation period.

[Tracheostomy and prolonged artificial ventilation of patients after heart surgery]. / Tracheostoma ir ilgalaike dirbtine plauciu ventiliacija ligoniams po sirdies operaciju.

Dysfunction of respiratory system after open heart surgery is one of the main problems in postoperative period. When mechanical ventilation is prolonged because of different causes, tracheostomy is usually performed, but the optimal time is still being discussed. In order to elucidate the influence of tracheostomy to subsequent course of disease we reviewed the indications, frequency and complications of postoperative tracheostomies performed in 1998-2000 in Cardiosurgical clinic after open heart surgery. The survey of our experience (only 15 tracheostomy procedures have been performed) showed that ventilation through tracheostomy tube is safe and comfortable way of application of prolonged mechanical ventilation: it is easier to stabilize, suction, and attach respiratory equipment. The patient can eat and, with some adjustments, can talk. Complications of tracheostomy are not often. If tracheostomy was well timed, the risk of trachea stenosis, infection of respiratory tract and other possible complications would decrease.

[The first clinical experience and technical peculiarities of mitral valve homograft implantation]. / Pirmoji klinikine patirtis ir techniniai ypatumai implantuojant mitralinio voztuvo homografta.

INTRODUCTION: Surgical interventions because of mitral valve disease have been ascribed since 1951. Many changes within mitral valve replacement have passed including closed and open mitral commissurotomy, mitral valve repair operations implantation of mechanical, biological heart valve and finally use of mitral valve homograft. Despite changes in chirurgical tactics and medico-technical environment, mitral valve homograft implantation remains one of the most complex surgical interventions. Surgical and technical details of mitral valve homograft implantation are discussed. OBJECTIVE: to estimate technical difficulties and anatomical positioning of mitral valve homograft considering a spectrum of indications of mitral valve replacement. CASE REPORT: 62-year-old woman 26 years ago underwent mitral valve replacement with Starr-Edwards mitral valve prosthesis, because of rheumatic heart disease by homograft. Due to malfunction of the mitral valve prosthesis, and progressive left ventricular failure patient was reoperated on 26(th) of February 2002. Fresh antibiotic preserved mitral valve homograft was implanted. Surgical techniques were guided using left ventricle size measurement indicated by echocardiography. RESULTS: The technique described by Acar/Carpentier was used except of mitral valve annuloplasty ring implantation. Peri- and early postoperative period was free of homograft related complications. The left ventricle function was improving and the heart size decreased dramatically during first postoperative week. CONCLUSION: The most important peculiarities for mitral valve homograft implantation are echocardiography data and intraoperative left ventricle measurements. Homograft implantation techniques are rather demanding therefore indications for mitral valve replacement have to be selected carefully and should be based on the presence of severe mitral valve dysfunction in order to achieve best hemodynamic results and prevent patient from anticoagulation therapy.