Operative experiences with thoracoabdominal aortic aneurysms.

During a 27-year period, resection of 690 aneurysms of the descending thoracic and/or abdominal aorta were performed. Thirty (4.3%) were thoracoabdominal aneurysms. Although the series of thoracoabdominal aneurysms is small, there was continued improvement in protection of the abdominal viscera and spinal cord from ischemic injury. Operative survivors experienced good late (68% at 5 yrs.) survival. Each of the last 12 pts. in the series survived the operation and 9 are still alive. The surgical results justify a more aggressive stance regarding resection of the thoracoabdominal aneurysms.

A no-flush, core-cooling technique for successful cardiopulmonary preservation in heart-lung transplantation.

In order to determine whether a no-flush, core-cooling technique could provide extended heart-lung preservation, we placed donor calves on cardiopulmonary bypass and instituted rapid cooling to 15 degrees C during the continuous infusion of isoproterenol. The heart and lungs were harvested after the administration of a cardioplegic solution through the aortic root. In the control group (N = 5), heart and lungs were orthotopically allotransplanted immediately. In the preserved group (N = 5), heart and lungs were similarly excised but were stored in a normal saline bath at 4 degrees C for approximately 4 hours and then transplanted. Both groups received isoproterenol during reperfusion and were studied for 6 hours after implantation. A load independent analysis of myocardial function was done by determining with a sonomicrometer the ratio of the end-systolic pressure to the end-systolic dimension. Pulmonary preservation was evaluated by measurement of extravascular lung water with a double-indicator dilution method, arterial oxygenation on 100% inspired oxygen, and serial lung biopsies. Myocardial and pulmonary function after 4 hours of static preservation was found to be similar to controls. No-flush, core-cooling with cardiopulmonary bypass provides adequate cardiorespiratory function after acute bovine heart-lung allotransplantation. With the use of this technique, successful extended cold ischemic cardiopulmonary preservation for heart-lung transplantation may be achieved.

Histologic pattern of early heart allograft rejection under cyclosporine treatment.

The histologic abnormalities associated with early heart rejection in cyclosporine-treated patients are not fully characterized. To study these abnormalities, Lewis rats received ACI heart-lung allografts and two weeks of cyclosporine treatment. Then the therapy was discontinued. Controls were sacrificed at that time; other animals were sacrificed three, six, and nine days later. The rejection score was determined solely by the percentage of necrotic myocardium, while 13 other histologic parameters were semi-quantitatively graded to identify parameters of early rejection of the heart. There was no evidence of myocardial necrosis or significant inflammation three days after discontinuation of therapy. At six and nine days, despite the absence of myocyte necrosis, there were significant increases in the grades for interstitial and endocardial inflammation, venous cuffing, perivascular inflammation with intermyocyte extension and arterial vasculitis. Our quantitative and semi-quantitative histologic analysis identified abnormalities of the early stage of heart rejection that may provide clues in defining rejection prior to the development of myocyte necrosis.