Biomedical subjects

S C Achuff

Publications and source records attributed to S C Achuff.

58 records · Page 4Linked to original sources

PubMedDate not supplied

Persistent pulmonary hypertension after heterotopic heart transplantation: a case report.

Right-sided failure occurring in the donor heart immediately after transplantation is primarily caused by increased recipient pulmonary artery pressure and resistance and represents one of the leading causes of perioperative mortality associated with orthotopic heart transplantation. After transplantation pulmonary hypertension gradually declines, returning to near normal levels within 30 days of transplantation. This article describes a case report of the persistence of pulmonary hypertension after heterotopic heart transplantation. The heterotopic position was utilized because of marked elevation of the pulmonary artery resistance (18 Wood units) calculated at the time of operation. Cardiac catheterization data-obtained during the subsequent 6 months of follow-up showed persistent elevation of pulmonary artery pressure and pulmonary vascular resistance. The patient, however, clinically continues to feel well and remains asymptomatic without signs of right-sided heart failure. Indications, suggested advantages, and demonstrated disadvantages of heterotopic heart transplantation are discussed.

Adult↗

PubMedDate not supplied

Acute right ventricular failure following heart transplantation: improvement with prostaglandin E1 and right ventricular assist.

Development of significant pulmonary hypertension following orthotopic heart transplantation can result in death caused by irreversible right ventricular failure. Despite determination of acceptable preoperative pulmonary vascular resistance, this complication may still occur. This report illustrates the technique of right ventricular assist and concomitant infusion of intrapulmonary prostaglandin E1 for the treatment of postoperative right ventricular failure resulting from pulmonary hypertension.

Acute Disease↗

PubMedDate not supplied

Arteriolar vasculitis on endomyocardial biopsy: a histologic predictor of poor outcome in cyclosporine-treated heart transplant recipients.

The histologic pattern of severe, potentially lethal cardiac rejection in transplant recipients who are treated with cyclosporine may be difficult to distinguish from mild or moderate rejection. The purpose of this study was to determine whether specific histologic abnormalities seen on endomyocardial biopsy could identify which histologic patterns of rejection are associated with progression to graft dysfunction or graft failure. We performed a blinded, retrospective analysis of endomyocardial biopsies from our initial 19 transplant recipients. Group 1 was composed of five patients who developed graft failure or dysfunction after transplantation. Group 2 was composed of the remaining 14 patients with normal hemodynamics and function at heart catheterization 1 year after transplantation. Seventeen histologic parameters were semiquantitatively graded, and comparisons between the two groups were made with the Student's t test. Of the 17 parameters, only arteriolar vasculitis was significantly increased in group 1 versus group 2 biopsies (p = 0.002). Arteriolar vasculitis was identified in four of five patients in group 1 and was unique to group 1. Of 53 group 1 biopsies, eight patients had foci of arteriolar vasculitis and were seen up to 88 days before graft failure. Therefore the finding of arteriolar vasculitis on endomyocardial biopsy may identify high risk rejection episodes in transplant recipients who are treated with cyclosporine.

Adult↗

PubMedDate not supplied

Aortic dissection in a cardiac allograft recipient: a case report.

Ascending aortic dissection is rare in cardiac allograft recipients. Only two patients with dissection arising from the native aorta have been reported previously and, unfortunately, the diagnosis was made postmortem in each instance. We report the first case of successful surgical treatment of aortic dissection confined to the donor aorta in a recipient of an orthotopic cardiac allograft.

Aortic Dissection↗