Subject(s)
Collateral Circulation , Counterpulsation , Myocardial Ischemia , Neovascularization, Physiologic , Aged, 80 and over , Coronary Circulation , Coronary Vessels/physiopathology , Counterpulsation/instrumentation , Counterpulsation/methods , Counterpulsation/trends , Heart-Assist Devices/trends , Humans , Male , Middle Aged , Myocardial Ischemia/physiopathology , Myocardial Ischemia/therapy , Russia , Severity of Illness Index , Treatment OutcomeABSTRACT
Exercise tolerance in postcardiac transplantation patients versus healthy controls was studied at different intervals after the surgery using bicycle ergometry. Being low after the transplantation, exercise tolerance in the patients increased throughout the rehabilitation period but still did not reach the values characteristic for healthy subjects. Initial heart rate in the above patients was higher, while chronotropic and inotropic reserves of the transplanted heart appeared lower than in the controls. The data obtained help objectively assess the condition of the patients with transplanted heart.
Subject(s)
Exercise Test , Heart Transplantation , Hemodynamics , Adolescent , Adult , Heart Rate , Humans , Middle Aged , Time FactorsABSTRACT
Compared to healthy controls, patients with transplanted heart have higher baseline heart rate (HR), delayed initial HR reaction, slower changes of HR both during exercise and after it, diminished chronotropic and inotropic reserves. The data obtained contribute to better understanding of physiology of transplanted denervated heart and objective assessment of patients after heart transplantation.
Subject(s)
Blood Pressure , Exercise/physiology , Heart Rate , Heart Transplantation/physiology , Adolescent , Adult , Exercise Test/methods , Exercise Test/statistics & numerical data , Follow-Up Studies , Heart/innervation , Heart/physiopathology , Humans , Middle AgedABSTRACT
Holter monitoring was performed in 15 patients surviving over 3 months after homotopic cardiac transplantation. The frequency and types of arrhythmias occurring in the grafted innervated heart were studied according to its postoperative period duration. The follow-up lasted 3 to 29 months. Supraventricular arrhythmias were detected in 80%, whereas ventricular ones were found in 86.7%. Ventricular arrhythmias accompanied chronic graft rejection in 2 patients. It was ascertained that Holter monitoring was of greater diagnostic value than routine ECG recording. Innervation is not essential in the occurrence of cardiac arrhythmias.
Subject(s)
Arrhythmias, Cardiac/etiology , Cardiomyopathy, Dilated/surgery , Coronary Disease/surgery , Heart Transplantation/adverse effects , Postoperative Complications/etiology , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/therapy , Electrocardiography , Female , Humans , Male , Pacemaker, Artificial , Postoperative Complications/diagnosis , Postoperative Complications/therapy , Sick Sinus Syndrome/diagnosis , Sick Sinus Syndrome/etiology , Sick Sinus Syndrome/therapy , Tachycardia/diagnosis , Tachycardia/etiology , Tachycardia/therapy , Tachycardia, Supraventricular/diagnosis , Tachycardia, Supraventricular/etiology , Tachycardia, Supraventricular/therapyABSTRACT
The work analyses infectious complications after 35 orthotopic transplantations of the heart. The infectious complications are divided into 2 groups. Group 1 consisted of 6 patients with local complications. Group 2 was made up of 8 patients who died from bacterial infectious complications (mediastinitis 3, sepsis 2), from miliary tuberculosis of the lungs 1, cytomegaloviral infection 1, and systemic candidiasis 1.
Subject(s)
Heart Transplantation , Infections/epidemiology , Postoperative Complications/epidemiology , Adolescent , Adult , Female , Humans , Infections/mortality , Male , Middle Aged , Postoperative Complications/mortality , Retrospective StudiesABSTRACT
Three cases of chronic rejection occurring 7.5, 10, and 24 months after transplantation of the heart are analysed. The clinical features of chronic rejection in the late-term periods after transplantation of the heart are discussed. The problems of clinical diagnosis of chronic rejection, the role of endomyocardial biopsy and disorders of lipid metabolism are dealt with. Tactics of saving the patient are recommended. The authors substantiate the necessity for heart retransplantation and, in the absence of a donor's heart, for two-stage transplantation of the heart through an artificial heart or a biventricular approach by means of artificial heart ventricles.
Subject(s)
Graft Rejection , Heart Transplantation , Adult , Humans , Male , Time FactorsABSTRACT
Tissue typing was used to study characteristic features of class I and II HLA-antigens distribution in two populations of young IHD patients: Russians (n-32) and Georgians (n-72). Healthy donors (267 Russians and 579 Georgians) served as controls. Genetic markers of IHD predisposition are revealed: for Russians relative risk for B12, DR1 equaled 2.95 and 3.65, respectively, and for Georgians 6.60, 3.02 and 2.33 for B21, Bw22 and DR2, respectively. The differences in markers of IHD predisposition in two populations belonging to the same race suggest than IHD predisposition gene in each population may be bound to various HLA antigen(s). This necessitates study of the markers not only in each race, but in each population as well.
Subject(s)
Coronary Disease/genetics , HLA Antigens/genetics , Adult , Coronary Disease/etiology , Disease Susceptibility , Female , Georgia (Republic) , HLA Antigens/analysis , HLA-A Antigens/analysis , HLA-A Antigens/genetics , HLA-B Antigens/analysis , HLA-B Antigens/genetics , HLA-DR Antigens/analysis , HLA-DR Antigens/genetics , Humans , Male , MoscowABSTRACT
The article discusses the first clinical experience of the donor maintenance of the program of heart transplantation. Under analysis are etiology and terms of the process of death of the brain in 65 potential donors. The authors propose a scheme of the three-stages assessment of fitness of his heart for transplantation. Specific features of intensive therapy of the donors are considered. Twenty donors were used for clinical transplantations of the heart, in 18 cases (90%) satisfactory recovery of functions of the transplanted heart was noted.
Subject(s)
Heart Diseases/surgery , Heart Transplantation/methods , Tissue Donors , Tissue and Organ Procurement/methods , Adolescent , Adult , Child , Female , Heart Transplantation/immunology , Histocompatibility Testing/methods , Humans , Male , Middle Aged , Tissue and Organ Procurement/standards , USSRABSTRACT
The article analyses the first clinical experience in orthotopic allotransplantation of the heart at the Scientific Research Institute of Transplantology and Artificial Organs, USSR Ministry of Health, in the period from October, 1986 to July, 1989 (26 transplantations of the heart and one two-stage transplantation of the heart with the use of "Poisk-10M" artificial heart for 3.5 days in the first stage). Eleven patients are alive. Follow-up periods: maximum over 2.5 years, minimum 3 months. Sixteen patients died in different periods (up to 12 months). Three-component therapy (cyclosporine A, methylprednisolone, azathioprine) was applied for immunosuppression. The authors analyse the problems of the selection of potential recipients (indications and contraindications) and donor, the optimum surgical techniques, complications of immunosuppressive therapy, and infectious complications. The first clinical experience in two-stage transplantation of the heart is analysed. The first experience in transplantation of the heart in patients allows the conclusion that the use of this method for the management of the terminal stage of congestive cardiac insufficiency is a reality.
Subject(s)
Coronary Disease/history , Heart Failure/history , Heart Transplantation/history , Adult , Coronary Disease/physiopathology , Coronary Disease/surgery , Heart Failure/physiopathology , Heart Failure/surgery , Heart Transplantation/adverse effects , Heart Transplantation/methods , Heart Transplantation/physiology , Hemodynamics/physiology , History, 20th Century , Humans , Middle Aged , Postoperative Complications/etiology , Tissue Donors , Tissue and Organ Procurement/methods , USSRABSTRACT
An analysis was made of the work carried out by the Department of Coronary Surgery and Heart Transplantation as regards heart transplantations during 1988. As many as 119 patients, hypothetical heart recipients, received medical advice. The Department refused hospitalization to 42 patients because of the nonconformity to the indications and contraindications to heart transplantation. 77 patients were admitted to the Department. During examinations and treatment, 53 persons were discharged from hospital. 8 patients died before donor's hearts were received. Donor's hearts were transplanted to 10 patients. 3 persons died from severe infectious complications on days 12, 15 and 43 after the operation. Following the operation 7 patients have been surviving from 4 to 17 months. The patients' status remains satisfactory. The functional parameters of the donor's heart are within normal. Taking into consideration the lack of the treatment methods for patients with terminal heart lesions, it is necessary that the number of operations be increased. A great importance in this case is attached to the joint efforts of internists and cardiologists, aimed at the screening and examination of potential heart recipients.
