ABSTRACT
Analysis of planned endomyocardial biopsy specimens of heart allotransplants from 22 recipients revealed signs of humoral type rejection (slight, medium, and severe) presenting as fixation of IgG, IgM, and complement components (C3, C4d) in 61 of 63 sections. Permanent presence of rejection signs attests to rheumatoid course of this process.
Subject(s)
Graft Rejection/immunology , Heart Transplantation/immunology , Adult , Biopsy , Capillaries/chemistry , Capillaries/immunology , Complement C3/immunology , Complement C4b/immunology , Coronary Vessels/chemistry , Coronary Vessels/immunology , Female , Fluorescein-5-isothiocyanate , Fluorescent Antibody Technique, Direct , Fluorescent Dyes , Graft Rejection/pathology , Heart Transplantation/pathology , Humans , Immunoglobulin G/immunology , Immunoglobulin M/immunology , Immunohistochemistry , Male , Myocardium/immunology , Peptide Fragments/immunology , Transplantation, HomologousABSTRACT
The authors present the analysis of their twelve-year experience in staged treatment of patients with combined pathology using coronary balloon angioplasty (CBA). CBA was performed in 83 patients (mean age 61.7 +/- 9.0 years) prior to heart valve replacement. Mean functional class according to New York Heart Association (NYHA) was 3.3 +/- 0.5. Thirty-one (37.3%) patients displayed signs of circulatory decompensation. Nine (10.8%) patients had had myocardial infarction. Thirteen (15.6%) patients had been operated on for valvular heart disease. The authors present their own method of staged treatment of combined pathology, describe and substantiate a regimen of therapy with desaggregants, the timing of the second stage of treatment, and post-operative therapy with desaggregants. In-hospital lethality was 8.4%, which was lower than the lethality of combined surgery (14.5%). Actual three-year survival rate was totally comparable to that of patients who had undergone a combined surgery (87.8% and 88%, respectively). The method of two-staged treatment of patients with combined (valvular plus coronary) pathology allows for a significant improvement in their surgical treatment, and deserves further study and clinical application.
