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Biomedical subjects

A Haverich

Publications and source records attributed to A Haverich.

At least 397 records · Page 22Linked to original sources
PubMed1988

Hyperimmuneglobulin for cytomegalovirus prophylaxis following heart transplantation.

Cytomegalovirus continues to be an important cause of morbidity and mortality following organ transplantation. In a series of 75 heart transplant patients, we have compared two protocols for prophylactic administration of CMV hyperimmuneglobulin. The first group of patients received immunoglobulin on the operative and on the tenth postoperative days. The second group of patients received immunoglobulins on the operative day, and repeatedly with each period of increased immunosuppression. With repeated doses of immunoglobulin prophylaxis, the incidence of CMV reactivation and the clinical severity of CMV infection were both significantly reduced. A reduction in the incidence of CMV infection in recipients who were seronegative preoperatively was also observed. (5/8 vs. 7/25 patients; P = 0.06). We conclude that repeated administration of specific hyperimmuneglobulin with each period of increased immunosuppression following heart transplantation has a beneficial effect on both CMV reactivation and infection.

Adult↗
PubMed1988

Surgical alternatives in the treatment of life-threatening ventricular arrhythmias.

We present our experience in the treatment of life-threatening ventricular tachycardia using electrophysiologically guided surgery (97 patients), automatic implantable cardioverter defibrillator (AICD) (42 patients), and orthotopic heart transplantation (15 patients). Eighty-three percent of these patients had ischemic and 17%, nonischemic heart disease. Our results of electrophysiologically directed surgery show an early mortality of 10% and a recurrence of 5% in the ischemic group. In the nonischemic group, the recurrence was 45%. The AICD was implanted in 31 patients with ischemic heart disease, in 5 with ventricular dysplasia, and in 6 with dilative cardiomyopathy, the ejection fractions ranging from 12% to 65%, with a mean of 30%. Early and late mortalities were 5% and 19%, respectively. The AICD was effective in all patients. Survival rate at 1 year was 83% +/- 6.4%. Thirteen of 15 patients have survived heart transplantation for 3-20 months (mean: 11 months). Ejection fractions prior to transplantation ranged from less than 10% to 34% (mean: 16%). We conclude that electrophysiologically guided surgery is highly effective in most cases of ischemia-related ventricular tachycardia. The AICD is considered a palliative alternative in patients with either poor ventricular function, no electrophysiological substrate, or multimorphological tachycardia. Heart transplantation has to be considered especially in young patients in whom progression of the underlying disease can be anticipated. Bridging by AICD is possible when transplantation is not immediately available or recommendable.

Adolescent↗
PubMed1988

High incidence of monoclonal immunoglobulins in patients after liver or heart transplantation.

Sera from 56 recipients of liver or heart transplants were investigated for monoclonal immunoglobulins (mIg) by immunofixation electrophoresis (IFE) at different times during 4 years after transplantation. Transient, changing, or stable mIgs were found in 18 patients. A significantly increased mIg incidence was observed in heart Tx patients, patients over 40 years of age, and those receiving azathioprine or antithymocyte globulin in addition to prednisolone and cyclosporine as immunosuppressive treatment. No correlations could be found between the presence of mIg and the number of rejection episodes or intercurrent infections. Such serum mIg represent monoclones of at least 1 x 10(9) cells of B lymphocyte lineage that apparently proliferate without adequate suppressive control. Since immunosuppressed allograft recipients are at risk of developing B cell lymphomas, such monoclones may be regarded as prelymphomas necessitating a careful follow-up in these patients.

Antibodies, Monoclonal↗
PubMed1988

Selective attenuation of endothelium-mediated vasodilation in atherosclerotic human coronary arteries.

This study was undertaken to determine whether atherosclerosis impairs relaxations mediated by endothelium-derived relaxing factor (EDRF) in human coronary arteries. Epicardial coronary arteries were obtained from the hearts of cardiac transplantation patients with or without histologically documented coronary atherosclerosis (atherosclerotic arteries were from patients aged 42-55 years, nonatherosclerotic arteries were from patients aged 14-24 years). Transverse strip preparations were mounted in organ baths for isometric tension recording. Tension was induced with prostaglandins F2 alpha. Indomethacin (10(-5) M) was present to prevent possible interference from endogenously formed prostaglandins. The EDRF-mediated relaxations in response to substance P (10(-10) to 10(-8) M), bradykinin (10(-9) to 10(-7) M), and Ca2+-ionophore A23187 (10(-9) to 10(-7) M) were significantly attenuated in atherosclerotic arteries. In deendothelialized tissues these compounds had no effect. In contrast, endothelium-independent relaxations induced by isoprenaline (10(-7) to 10(-5) M) were not affected by atherosclerosis. Atherosclerotic arteries showed also normal relaxations with high concentrations of glyceryl trinitrate (10(-8) to 10(-7) M), but reduced relaxations with a lower concentration of the compound (10(-9) M). Acetylcholine (10(-7) to 10(-6) M) only produced endothelium-dependent relaxations in 8 of 60 arterial preparations (with or without atherosclerosis). In most of the arteries, it was a direct vasoconstrictor (which may have masked EDRF release in many cases). Omission of indomethacin from the bath solution increased the incidence of moderate acetylcholine-induced relaxations (9 of 16 preparations). It is concluded that atherosclerosis attenuates EDRF-mediated vasospasm and myocardial ischemia.

Acetylcholine↗
PubMed1988

Distant heart procurement. Impacts of storage solution composition on cardiac performance following transplantation.

In distant heart procurement, optimal storage conditions remain to be defined, especially with respect to the electrolytic concentrations of storage solutions. Between December 1986 and April 1987, heart transplants were carried out in 18 patients. After cardioplegic arrest (St. Thomas), the hearts were randomly stored in either Euro-Collins' solution (ECS; n = 9) or Ringer's solution (RS; n = 9) at 4 degrees C. For the first 24 h postsurgery, atrial pressures (LAP, RAP), systemic (MAP) and pulmonary pressures (PAP), and cardiac output (CO) were monitored. In addition, catecholamine and nitroglycerin requirements as well as the type of cardiac rhythm were documented. There was no significant difference between the groups in terms of the period of graft ischemia (ECS, 162 +/- 28 min; RS, 141 +/- 47 min); the MAP, RAP, LAP, and CO were also similar in both groups. The total amount of epinephrine needed to maintain the MAP between 60 and 80 mm Hg was 10.5 mg/24 h +/- 4.1 mg in ECS compared with 19.9 mg/24 h +/- 12 mg in RS (P less than 0.05). Despite less inotropic support, the left cardiac work index was considerably higher in the ECS group (P less than 0.05). In the first few postoperative hours, 8/9 RS patients needed either atrial (n = 4) or ventricular pacing (n = 4) for a heart rate of 90-100 beats/min (bpm), whereas only three ECS patients required atrial pacing (P less than 0.05). All other ECS hearts showed a spontaneous sinus rhythm.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Oxygen-derived free radical scavengers for amelioration of reperfusion damage in heart transplantation.

In this study we tried to define the possible benefits of the oxygen-derived free radical scavengers after 3 hours of cold myocardial global ischemia, as required in the setting of cardiac transplantation. Twenty-one pig hearts were harvested after preservation with a cold cardioplegic solution (St. Thomas' Hospital solution) and topical cooling. Normothermic reperfusion with blood was achieved with a special heart-lung machine preparation, which allows the heart to beat in a working or nonworking mode. Twelve hearts served as control hearts (group I), and nine (group II) were subjected to superoxide dismutase and catalase. Superoxide dismutase was applied at a dose of 40 U/ml of cardioplegic solution and 1500 U/kg body weight with the start of reperfusion. Catalase was added to the cardioplegic solution in a dose of 100 U/kg and 3500 U/kg body weight with the start of reperfusion. After 15 minutes of retrograde reperfusion, both left ventricular developed pressure and its first derivative were significantly higher in group II (137 +/- 7.6 mm Hg, 2467 +/- 162 mm Hg/sec) than in group I (105 +/- 6 mm Hg, 1676 +/- 231 mm Hg/sec, p less than 0.05 for each). In addition, a considerably higher coronary blood flow was observed in group II throughout the 180-minute period of reperfusion (p = 0.047). We therefore conclude that the combined administration of superoxide dismutase and catalase during the initial period of cardioplegic arrest and during early reperfusion of donor hearts submitted to 3 hours of cold ischemia has a beneficial effect on myocardial performance.

Animals↗
PubMed1987

[Management of rejection following heart transplantation using oral steroid medication].

After 47 orthotopic heart transplantations with long-term immunosuppression (cyclosporin A, 3-10 mg/kg; azathioprine, 1-2 mg/kg; prednisolone 0.1 mg/kg) there were 306 episodes of acute rejection. In 44 of these (14.8%) the oral prednisolone dosage was increased, from a mean of 10.8 +/- 2.95 mg/d to 36.6 +/- 7.2 mg/d, followed by stepwise reduction to the original maintenance dose. Compared with the customary intravenous bolus administration (1.0 g/d for three days: success rate 89%), the oral schedule was successful in 33 of the 44 episodes of rejection (75%). It is concluded that in selected patients acute rejection episodes after heart transplantation can be successful treated by an increase in the oral dose of steroids without changing the dosage of the other two immunosuppressive drugs.

Adolescent↗
PubMed1987

[Transient HIV-antibody positive tests in heart transplantation patients after repeated administration of a CMV immune globulin preparation].

After repeated administration of relatively high doses of a cytomegalovirus immunoglobulin preparation to two patients after heart transplantation, both the ELISA and the immuno-blot tests became temporarily positive (for 21 and 41 days, respectively) to HIV antibodies. The CMV immunoglobulin preparation was demonstrated to have high HIV antibody titres. The latter ran parallel to antibody titres against measles virus, also transferred passively with the immunoglobulin preparation. This makes it unlikely that HIV antibodies had been formed by active immunization from HIV in the immunoglobulin preparation. Within 126 and 176 days, respectively, after the last positive test against HIV antibodies there was no further demonstration of HIV antibodies or of a corresponding illness. There was thus no evidence of an HIV infection having been transmitted by the immunoglobulin preparation.

Antibodies, Viral↗
PubMed1987

Results of orthotopic heart transplantation for ischaemic cardiomyopathy.

From July 1983 to May 1987, 172 orthotopic heart transplantations were performed in 165 patients. Of these, 46 recipients (39 male, 7 female), aged between 26 and 56 years (mean age 47), suffered from ischaemic cardiomyopathy. Postoperative immunosuppression consisted of a triple drug regimen of cyclosporine A, azathioprine and, in the last 31 patients, low-dose steroids. The actuarial survival in this group of patients at 1 year and at 2 years was 71.9%. There were five early deaths: three due to acute rejection and two from multiple-organ failure and sepsis. Of the eight late deaths, two could be attributed to acute cardiac rejection and four to bacterial infections. In two patients, sudden death occurred in the presence of accelerated graft atherosclerosis. Mild-to-moderate coronary artery lesions were seen in five other patients undergoing angiography one year after transplantation. Apart from the well-known postoperative risk factors in cardiac transplant recipients, accelerated graft atherosclerosis appears to be an additional hazard in the subgroup surgically treated for ischaemic cardiomyopathy.

Adult↗
PubMed1987

Acute type-A dissection of the aorta: which diagnostic modes remain for surgical indication?

The natural course of acute type-A dissection of the aorta (AADA) implies a mortality of 50% within the initial 2 days. Preoperative diagnostic tests have to be expeditious while avoiding hypertension and direct manipulation of the aneurysm to prevent aortic rupture. Since 1979, 51 patients have been operated upon for AADA. The diagnosis was established by one or more of the following methods: transthoracic echocardiography (TTE); transesophageal echocardiography (TEE); conventional angiography (CA); intravenous digital subtraction angiography (DSA); and computed tomography with bolus injection of contrast medium (CT). TTE (n = 26) showed a dissection in 72%, suggested an intimal flap in 25%, and missed the diagnosis in 1 case. CT (n = 15) and DSA (n = 10) failed to indicate dissection in 1 case each. CA (n = 27) demonstrated dissection in every case but was the most time-consuming and stressful method. Since the introduction of combined transthoracic and transesophageal echocardiography, no other diagnostic methods have been used. On the basis of this experience, we propose the following diagnostic plan: 1. in AADA, the demonstration of an intimal flap in the ascending aorta by TTE/TEE is an indication for immediate surgery without further diagnostic measures (10 patients: no false-positive findings); 2. if a dissection is suggested by TTE/TEE, then DSA is performed if the supra-aortic branches are suspected to be compromised; CT is preferred if an extrapericardial aortic rupture is suspected; 3. the time-consuming and stressful diagnostic approach of conventional angiography is no longer indicated.

Acute Disease↗
PubMed1987

A new look at acute type-A dissection of the aorta.

A new method of treating acute type-A dissection of the aorta is described and illustrated. It involves the reconstruction of both the valve and the ascending aorta. This procedure was employed in 17 patients, 2 of whom succumbed early of complications unrelated to the method while one committed suicide at a later date. One of the surviving patients required reoperation due to breakdown of a resuspended aortic commissure. Two patients show minor non-progressive valve regurgitation in the absence of annulo-aortic ectasia. Two patients have developed dilatation of the aortic root--one will require reoperation in the foreseeable future. In our hands, this method has served to make emergency operation for acute aortic dissection both simpler and safer. The limitations of its use are discussed.

Acute Disease↗