Cardiac transplantation--first year experience in a community hospital: a three year follow-up.

This is a report of ten consecutive patients with end-stage cardiac disease treated with orthotopic cardiac transplantation in a community hospital, during the first year of its heart transplantation program. All patients were followed for a minimum of 33 months and a maximum of 45 months with 100% survival at two years and 90% at three years. All survivors are presently in N.Y.H.A. Class I or II. The entire group of patients received the same triple immunosuppressive therapy. The incidence of infection and rejection during the first three months post-transplantation was 0.3 and 0.6 episodes per patient respectively. Every patient developed some degree of deterioration in renal function and 80% of the patients now receive treatment for systemic hypertension. The in-hospital institution cost for the transplant admission varied from $25,084 to $74,164. To date, 30 patients have undergone heart transplantation in our program and 26 are long-term successes. This study again proves that renal insufficiency and hypertension remain the major side effects of Cyclosporine therapy. We further conclude from our experience that cardiac transplantation can be successfully and cost effectively performed in a community hospital even with a somewhat lower caseload.

Two episodes of cytomegalovirus-associated colon perforation after heart transplantation with successful result.

A patient with end-stage heart disease was discharged from the hospital on postoperative day 7 after orthotopic heart transplantation. Three weeks from the day of operation, he developed sigmoid colon perforation, which required Hartmann's procedure, and 2 weeks later he had cecal disruption. A pathologic specimen showed underlying diverticular disease with associated cytomegalovirus colitis. Subsequently, the patient had multiple complications. Three months after colon perforation, the patient left the hospital, and now 1 year after transplantation he continues to do well. To the best of our knowledge, this is the first reported case of a patient who survived multiple colon perforations soon after heart transplantation.

True aneurysm of the pancreaticoduodenal artery: a case report and review of the literature.

A case of aneurysm of the pancreaticoduodenal artery is reported. Its differences from false aneurysms of the same artery are defined. The use of CT as a screening instrument and angiography as the definitive diagnostic tool is suggested to avoid undue delay in corrective treatment.

Unusual symptom in patient with pseudoaneurysm of the left ventricle and review of the literature.

A case of pseudoaneurysm developing 2 years after left ventricular aneurysmectomy and single coronary artery bypass graft is reported. A hypothesis that pseudoaneurysms developing after transmyocardial incision begin in surgery or shortly thereafter is postulated. Chest X-ray films as a preliminary test to direct attention to the diagnosis are recommended. An aggressive surgical approach is suggested. To our knowledge, this is the sixth known reported case in the literature with hemoptysis as the chief symptomatic feature.

Training in advanced cardiac life support.

The nationally recognized training and certification program in Advanced Cardiac Life Support consists of lecture material and a new concept in training and testing for the practical skills of Advanced Cardiac Life Support. The course content follows closely the concepts of advanced life support as explained in the standards on cardiopulmonary resuscitation and emergency cardiac care.

Aortic root dissection: echocardiographic demon-stration of torn intimal flap.

An unusual case of aortic root aneurysm with dissection is described. A large intimal tear allowed a flap of aortic tissue to sag into the lumen. The echocardiographic and angiographic findings simulated an aortic supravalvular membrane. Surgical replacement of the aortic valve and aortic root was successfully accomplished.