Total orthotopic heart transplantation (TOHT) requires longer ischemic time than standard orthotopic heart transplantation (SOHT) due to bicaval and pulmonary venous anastomoses, but offers normal ...anatomy and synchronous contractions of the atria as well as a normal ventricular filling pattern
To test if TOHT improves resting hemodynamics despite prolonged ischemic time, we analyzed 60 pts with SOHT and 66 with TOHT transplanted between 12/89 and 2/93. Ischemic time was different (142±37 vs 161±36min, p=0.004). Demographics, NYHA class, LVEF, myopathy, donor demographics and inotropes were similar. Right heart catheterization data were obtained at each endomyocardial biopsy. We included data from biopsies at 2 weeks (47 vs 50 pts) and 6 months (46 vs 46 pts) posttransplant that were free from humoral or ≥IB cellular rejection. Pts with pacemaker insertion, atrial fibrillation or β-blocker therapy at the time of biopsy were excluded
Cardiac output and index were higher in the TOHT group at 2 weeks (6.1±1.4 vs 5.4±1.0I/min, p=0.01; 3.3±0.7 vs 2.9±0.6I/min/m2, p=0.005) but similar at 6 months (5.9±1.2 vs 5.6±1.4I/min. p=NS; 3.0±0.6 vs 2.9±0.7I/min/m2, p=NS). Right atrial mean pressure (RAM, mmHgI was lower with TOHT vs SOHT at both time intervals (7±4 vs 9±4, p=0.02 and 5±2 vs 7±3, p=0.0006). Pulmonary arterial (PAM) and left atrial mean pressure (PCWP) (mmHg) were similar at 2 weeks (21±6 vs 23±6, p=NS; 12±5 vs 13±5, p=NS). At 6 months PAM was similar (20±7 vs 22±6, P=NS) but PCWP was lower in the TOHT group (11±5 vs 13±5, p=0.045). Pulmonary vascular resistance (PVR, Wood-Units) was similar at 2 weeks (16±0.7 vs 1.9±1.0, p=NS) and 6 months (1.6±0.7 vs 1.7±1.0, P=NS). Heart rate (bpm) was higher at 2 weeks and 6 months with TOHT than SOHT (84±10 vs 75±12, P=0.0003 and 90±12 vs 82±9, p=0.0006).
Despite a longer ischemic time, total orthotopic heart transplantation does not impair postoperative cardiac function. There is an early improvement in cardiac output, a sustained higher heart rate reflecting preservation of donor sinus node function, and a lower RA pressure, perhaps due to less tricuspid regurgitation.
Successful thrombolysis alters the pattern of creatine kinase (CK) release to the plasma after acute myocardial infarction (AMI). Among the important differences there are the early peak of the CK ...activity curve and the higher peak value for a given infarct size. To determine whether the magnitude of peak CK following thrombolysis still reflects the extent of myocardial damage, we correlated the peak CK value with left ventricular ejection fraction (LVEF) in 114 patients with first anterior AMI who had early peak CK ( < or = 12 h) after thrombolysis. There was a significant (p < 0.001) linear relation between the peak CK value and LVEF both at admission and 2 months later. High ( > or = 1,500 IU/1) as compared with low early peak CK was associated with significantly lower LVEF (p < 0.001) and a higher incidence of poor LVEF (p < 0.05).
We report on a 40 year old woman who presented with typical unstable angina pectoris associated with pulmonary oedema, due to poorly controlled hyperthyroidism. No cardiac abnormality was detected by ...echo-Doppler and nuclear ventriculography. Coronary angiography demonstrated normal coronary arteries. This case represents a new manifestation of the known association of cardiac ischaemia with hyperthyroidism in the presence of normal coronary arteries.
Discussions of the ethics involved in allocating scarce resources often proceed without a grounding in factual experience. This study explored whether there was statistical evidence to support the ...use of set age limits in patient selection criteria for heart transplantation. Many transplant teams have selection criteria that include age limits, excluding patients more than 60 or 65 years of age from being considered as transplant candidates. The hypothesis was made that patients in the age bracket of 60–69 should have a comparable success rate with transplantation to that of younger recipients when selected by using the same medical and psychiatric criteria. Based on their clinical observations, the authors postulated that the elderly would report better quality of life postoperatively than younger control subjects.
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