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Biomedical subjects

V R Zales

Publications and source records attributed to V R Zales.

At least 37 records · Page 2Linked to original sources
PubMed1993

Biventricular repair of hypoplastic right ventricle assisted by pulsatile bidirectional cavopulmonary anastomosis.

The right ventricle in patients with severe outflow obstruction or atresia and a small tricuspid valve often remains too hypoplastic even after optimal palliation to tolerate biventricular repair with closure of the atrial septal defect. In these patients, nonpulsatile cavopulmonary (Glenn) anastomosis has traditionally facilitated biventricular repair. In 1989, Billingsley and associates reported the addition of a bidirectional cavopulmonary anastomosis to the definitive biventricular repair in patients with hypoplastic right ventricle, pulmonary atresia, and intact ventricular septum. The atrial septal defect was left open with an adjustable snare for later closure. We report five patients with hypoplastic right ventricle (mean diastolic volume 48.4%, mean stroke volume 40.2% of predicted value) who had the atrial septal defect closed at the time of the biventricular repair. Four patients, who had the bidirectional cavopulmonary anastomosis supplementing the biventricular repair, had no evidence of excessive right atrial or superior vena cava hypertension postoperatively. One patient, who had atypical tetralogy of Fallot with tricuspid stenosis, developed recurrent pericardial tamponade and marked hepatomegaly following conventional tetralogy repair with closure of the atrial septal defect. These complications were controlled with the addition of bidirectional cavopulmonary anastomosis 2 months later. Postoperative hemodynamic or Doppler studies in these patients revealed pulsatile flow in the entire pulmonary artery system, including the artery distal to the Glenn anastomosis. This modification of biventricular repair allows primary closure of the atrial septal defect and provides pulsatile arterial flow in the entire pulmonary artery, even when the right ventricle is significantly hypoplastic.

Adult↗
PubMed1992

Ventricular volume growth after cardiac transplantation in infants and children.

BACKGROUND: Intermediate-term survival after pediatric cardiac transplantation continues to improve. However, little is known about cardiac function and especially ventricular growth in young patients after cardiac transplantation. The purpose of this study was to evaluate serially the hemodynamics, left ventricular (LV) volume, and ventricular function after cardiac transplantation in infants and children. METHODS AND RESULTS: Indications for cardiac transplantation were dilated cardiomyopathy (eight patients), hypoplastic left heart syndrome (six patients), and postoperative structural congenital heart disease (three patients). The age at time of transplant ranged from 7 days to 15 years (median, 3.5 years). The mean follow-up was 30.3 months (range, 13-46 months). Serial annual cardiac catheterizations were performed 1 year (17), 2 years (15), and 3 years (seven) after transplant. Measurements included right and left heart pressures, cardiac index, and LV volume and ejection fraction (Lange). Cumulative results (expressed as mean +/- SD) were pulmonary artery pressure, 14.9 +/- 3.2 mm Hg; LV end-diastolic pressure, 7.7 +/- 2.6 mm Hg; cardiac index, 3.5 +/- 0.52 l/min.m-2; and pulmonary vascular resistance, 2.02 +/- 0.76 units/m2. LV end-diastolic volume increased as patients grew, so that left ventricular end-diastolic volume remained 90 +/- 14% of that predicted for body surface area. The ejection fraction was 99 +/- 6% of that predicted. There was no evidence of chronic rejection by endomyocardial biopsy. No accelerated coronary artery atherosclerosis was identified. CONCLUSIONS: Serial studies in these young patients demonstrate normal hemodynamics and LV function after cardiac transplantation. Cardiac transplantation is associated with normal LV volume growth despite immunosuppression and denervation.

Adolescent↗
PubMed1992

Fenestrated Fontan with delayed catheter closure. Effects of volume loading and baffle fenestration on cardiac index and oxygen delivery.

BACKGROUND. The fenestrated Fontan operation has been applied to high-risk patients with univentricular hearts, resulting in improved survival. The purpose of this study was to determine the hemodynamic factors responsible for these improved results. METHODS AND RESULTS. We performed the fenestrated Fontan operation in 17 high-risk patients with univentricular hearts (median age, 3 years; age range, 1.2-25 years). High-risk characteristics were depressed ventricular function and/or hypertrophy (n = 12), atrioventricular valve insufficiency (n = 5), pulmonary artery distortion (n = 6), elevated pulmonary vascular resistance (> 2 units/m2) (n = 4), previously failed Fontan operation (n = 2), or associated Wolff-Parkinson-White syndrome (n = 1). Intraoperative hemodynamic measurements (n = 8) included cardiac index (by aortic flow probe), peripheral arterial O2 saturations, and left and right atrial pressures during inflow occlusion, followed by volume loading with open versus closed fenestration. Mean baffle fenestration was 3.5 mm (range, 2.7-5.0 mm). Multiple regression analysis (cardiac index versus atrial pressure) revealed cardiac index was greater with open than with closed fenestration (p < 0.001) during volume loading. Oxygen delivery (cardiac index multiplied by oxygen content) was also greater with open than with closed fenestration (p < 0.001). Survival was 100% with a mean follow-up of 10.4 months; pleural drainage was high in two patients. Subsequent transcatheter fenestration closure resulted in increased O2 saturation (87 +/- 1% to 96 +/- 0.3%, p < 0.05). CONCLUSIONS. The fenestrated Fontan operation improves survival in high-risk patients by increasing cardiac index and maintaining oxygen delivery, despite mild arterial O2 desaturation. Subsequent transcatheter fenestration closure can be performed after hemodynamic assessment.

Cardiac Catheterization↗
PubMed1992

Anomalous origin of the left coronary artery. A twenty-year review of surgical management.

Children with anomalous origin of the left coronary artery from the pulmonary artery are at risk for myocardial infarction and death. Surgical management of this condition in children has evolved significantly during the past 20 years. Between 1970 and 1990, a total of 20 of these patients underwent surgical intervention at two institutions. Age at operation ranged from 3 weeks to 11 years (mean, 26 months). Twelve patients had congestive heart failure, three were in cardiogenic shock, and two had cardiac murmurs. Operative techniques included ligation (n = 9), subclavian artery anastomosis (n = 5), aortic implantation (n = 3), internal mammary artery anastomosis (n = 1), intrapulmonary tunnel from aortopulmonary window to coronary artery (n = 1), and cardiac transplantation (n = 1). The three deaths in the series occurred at 3 weeks, at 2 months, and at 9 years after ligation. There have been no deaths after establishment of a two coronary artery system or after transplantation. Two of the five patients who had subclavian artery anastomosis to the anomalous coronary artery have severe anastomotic stenosis and collateralization. For patients with anomalous origin of the left coronary artery from the pulmonary artery, we recommend direct aortic implantation of the anomalous coronary artery at the time of diagnosis. Intrapulmonary tunnel from aortopulmonary window to coronary artery, or aorta-coronary bypass with internal mammary artery are recommended for children in whom aortic implantation is not anatomically feasible. Left coronary artery ligation is not indicated for these patients; those who have survived ligation should be considered for elective establishment of a two coronary artery system because of the risk of late death.

Anastomosis, Surgical↗
PubMed1991

Living-related lobar lung transplantation in beagle puppies.

Unilateral lung transplantation has provided effective short-term therapy in adults with end-stage lung disease. Rejection continues to be the most common cause of transplant failure. Living-related lung transplantation may decrease the recipient immune response. The purpose of this study is to test the technical and physiological feasibility of living-related lobar lung transplantation from adult beagles into beagle puppies in a chronic model. Twenty purebred adult beagle donors underwent left thoracotomy with harvest of the left lower lobe using cold perfusion of the pulmonary artery and cold immersion. Twenty recipient purebred beagle puppies from the same colony underwent left thoracotomy, left pneumonectomy, and implantation of the donor adult lobe. Anastomoses were performed in sequence: pulmonary vein to left atrium, bronchus, pulmonary artery. Postoperative immunosuppression was with Cyclosporine. Respiratory function of the implanted lobe was evaluated by pulmonary angiography and during balloon occlusion of the right pulmonary artery with arterial blood gases 1 month after transplantation. Ten recipient puppies died of rejection (4), infection (3), or bronchial dehiscence (3) prior to angiography. Seventeen pulmonary angiograms in 10 surviving animals showed normal left pulmonary arterial blood flow (2), diminished left pulmonary arterial flow (5), and occluded left pulmonary artery (3). In two recipients balloon occlusion of the right pulmonary artery was performed and respiratory function was maintained solely by the transplanted lobe for 2 days in one recipient and for 30 minutes at 1 month and 2 months postimplant in a second recipient. Living-related lung transplantation of adult beagle lobes into pneumonectomized beagle puppies is technically feasible. High mortality rates in a chronic model are related to infection and rejection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Surgical management of the conal (supracristal) ventricular septal defect.

Surgical management of the conal (supracristal) ventricular septal defect differs significantly from the management of the perimembranous (infracristal) ventricular septal defect. The absence of a portion of the conal septum can lead to prolapse of the right cusp of the aortic valve, which predisposes these patients to aortic insufficiency. Between January 1980 and December 1989, 36 children with conal ventricular septal defect underwent intracardiac repair. Diagnosis was by echocardiography, cardiac catheterization, and intraoperative exploration. Preoperative evaluation showed that 26 patients (72%) had aortic valve prolapse and 16 (44%) had aortic insufficiency. Pulmonary-to-systemic flow ratios ranged from 1:1 to 3.5:1 (mean 2.0:1.0). Ten patients (27%) were believed to have clinical congestive heart failure. Age at the time of operation ranged from 2 weeks to 18 years (mean 5.5 years). Operative exposure was through the pulmonary artery (26), aorta (4), right ventricle (3), or right atrium (3). Simultaneous aortic valve suspension for aortic insufficiency was performed in four patients. Operative survival was 100%. Follow-up is complete in all patients and ranges from 0.5 to 9 years (mean 4.3 years). All patients are in normal sinus rhythm. No residual ventricular septal defects have been identified. Twenty-three of 36 patients (64%) have no evidence of aortic insufficiency; 12 of 36 (33%) have trivial or mild aortic insufficiency. One patient with initial severe aortic insufficiency underwent repeat aortic valvuloplasty 3 years after ventricular septal defect closure and aortic valve suspension. No patients have required aortic valve replacement. Surgical management of the conal ventricular septal defect differs from that of the perimembranous ventricular septal defect in two critical aspects. The operative approach should be through the pulmonary artery. This allows the best exposure of the remaining conal septum and the pulmonary and aortic valve leaflets, facilitating closure of the defect without injury to the valves or conduction system. Conal ventricular septal defects should undergo early closure, regardless of shunt volume, to prevent progressive aortic insufficiency.

Adolescent↗
PubMed1991

Intermediate term results of infant orthotopic cardiac transplantation from two centers.

Orthotopic cardiac transplantation has become established for selected infants with severe forms of congenital heart disease. This study reviews the combined experience and intermediate term results of infants undergoing orthotopic cardiac transplantation from Children's Memorial Hospital, Chicago, and Kosair Children's Hospital, Louisville. From June 1986 through December 1989, 20 orthotopic cardiac transplantations were performed in 19 patients. Sixteen patients had variants of hypoplastic left heart syndrome. One infant had anomalous origin of the left coronary artery with severe ischemic cardiomyopathy. Two infants had aortic stenosis with endocardial fibroelastosis, and one had extracorporeal membrane oxygenation as a bridge to transplantation. Immunosuppression included cyclosporine, azathioprine (Imuran), and corticosteroids with an effort to wean the patients from steroids by 6 months to 2 years. Three early deaths resulted--from technical errors in two patients and from hyperacute rejection in one patient at 3 days. Four late deaths have occurred. Two patients died at 2 and 13 months of acute rejection. One patient died at 15 months of acute rejection after retransplantation. One patient died at 7 months of respiratory syncytial viral pneumonia. The remaining 12 patients are surviving 5 to 47 months (means 20 months) after orthotopic cardiac transplantation. Rejection surveillance in the first 6 months is by clinical signs supplemented by echocardiography, electrocardiography, and cell cycle analysis; endomyocardial biopsy is used after 6 months of age. For the cumulative series, 24 episodes of suspected rejection have been treated during 277 at-risk patient months with intravenous methylprednisolone (Solu-Medrol) (n = 18) and monoclonal antibody (OKT3) (n = 6), for an incidence of 1.04 episodes of rejection per patient per year. Serious posttransplantation infections including endocarditis, catheter sepsis, meningitis, and colonic perforation were successfully treated in four patients. Subjectively, their quality of life is excellent as shown by normal growth and developmental milestones and a low hospital readmission rate (1.4 episodes per patient per year). These encouraging intermediate term results warrant continued application of infant orthotopic cardiac transplantation for severe forms of congenital heart disease.

Antibodies, Monoclonal↗
PubMed1990

Massive primary chylopericardium: a case report.

A large pericardial effusion was discovered in an asymptomatic 12-year-old boy admitted for an elective orthopedic procedure. On physical examination, heart rate was 96 and blood pressure was 130/70 without paradox. The neck veins were not distended, but heart tones were distant. Chest roentgenogram (CXR) showed an enlarged cardiac silhouette. Echocardiogram showed a massive pericardial effusion compressing the right atrium, with depressed ventricular contractility. Pericardiocentesis yielded 450 mL of chylous fluid. A percutaneous pericardial drain was placed and drained another 400 mL of chyle. Pericardial fluid reaccumulated even though the patient was on a low-fat diet, and 1 week after admission left thoracotomy was performed with partial pericardiectomy and pericardial window. There was 1 L of chyle in the pericardial sac; frozen section of the pericardium showed lymphangiectasia. Chest tube drainage diminished rapidly and the patient was discharged. Follow-up CXR at 1 week showed fluid in both pleural spaces requiring bilateral tube thoracostomies again draining chyle. Even with total parenteral nutrition (TPN), 500 mL/d of chyle drained from the pleural tubes. Right thoracotomy with ligation of the thoracic duct was performed after 1 week of TPN. Pleural drainage abruptly dropped, and there has been no reaccumulation in either the pleural spaces or pericardium at 6-month follow-up. This case dramatically supports early thoracic duct ligation and partial pericardiectomy as the treatment of choice for primary massive chylopericardium.

Child↗
PubMed1990

Exit block in pediatric cardiac pacing. Comparison of the suture-type and fishhook epicardial electrodes.

Ninety-seven consecutive permanent epicardial pacemaker implantations were performed with either suture-type (group I, n = 52) or fishhook electrodes (group II, n = 45). In addition to epicardial fixation of the electrodes at the collar area, the suture-type was further secured in place by tying the electrode's suture at its exit to another nonabsorbable pledget-supported suture. Acute thresholds and slew rates were not significantly different between the two groups. Although the R wave was lower in group I (8.4 +/- 3.5 mV) than in group II (11.8 +/- 6, p less than 0.01), no sensing problems occurred. The larger surface area of suture-type electrode led to lower resistance in group I (271 +/- 61 omega) compared with group II (356 +/- 72, p less than 0.001); however, the difference in pacemaker generator longevity did not appear significant (group I, n = 12, mean 4.7 +/- 1.6 years; group II, n = 4, mean 5 +/- 0.6 years). The incidence of exit block was significantly higher in group II (40%, 18/45) than in group I (8%, 4/52, p less than 0.01). The length of the stimulation tip and better fixation of the suture-type electrode probably accounted for the observed difference in the incidence of exit block between the two electrodes.

Adolescent↗
PubMed1990

An alternative approach to the surgical management of physiologically corrected transposition with ventricular septal defect and pulmonary stenosis or atresia.

A modified approach to the surgical management of corrected transposition of the great vessels with ventricular septal defect and pulmonary stenosis or atresia was used successfully in two patients. The procedure consisted of performing a venous switch operation, directing the blood flow from the morphologically left ventricle (right-sided chamber) into the aorta through the ventricular septal defect and inserting a valved conduit between the left-sided morphologically right ventricle and the pulmonary artery. This approach has several advantages when compared with the traditional surgical management, which consists of closure of the ventricular septal defect and a left ventricular (right-sided chamber) to pulmonary artery conduit. It uses the morphologically left ventricle as the systemic pumping chamber, thereby minimizing long-term ventricular failure. It allows closure of the defect from the right ventricular side of the septum, thus decreasing the prevalence of complete atrioventricular block. It also avoids use of the tricuspid valve as the systemic atrioventricular valve and therefore decreases the chance of postoperative valve regurgitation.

Adult↗
PubMed1989

Direct tricuspid closure versus atrial partitioning in Fontan operation for complex lesions.

Thirty-three patients with complex lesions undergoing the Fontan operation needed either direct tricuspid closure (group 1, 14 patients) or atrial partitioning (group 2, 19 patients). In group 1, the tricuspid patch was sutured to the annulus leaving the coronary sinus draining to the systemic venous atrium. In group 2, atrial partitioning was accomplished with either a Dacron or a polytetrafluoroethylene patch, leaving the coronary sinus draining to the pulmonary venous atrium. Intraoperative distention of the left side was used to check for residual defects. In group 1, complete heart block developed in 5 patients (36%) and patch disruption, in 4 patients (29%). There were 3 late deaths (21%), which were due to sudden death, sepsis caused by Candida, and liver failure. In group 2, no patient had heart block, and patch disruption developed in 1 patient (5%). There was 1 early death (5%) and 2 late deaths (11%), which were due to sepsis caused by Candida and renal failure. Our experience suggests that atrial partitioning is a better approach than direct tricuspid patch closure in patients with complex lesions undergoing the Fontan operation.

Adolescent↗
PubMed1989

When should the hypoplastic right ventricle be used in a Fontan operation? An experimental and clinical correlation.

Eight anesthetized dogs underwent closure of the tricuspid valve and a Fontan procedure, and the right ventricular cavity was reduced in stepwise fashion. There was an increase in right atrial pressure from 9.3 +/- 2.2 to 14.1 +/- 2.4 mm Hg (p less than 0.001), a decrease in pulmonary artery pulse pressure from 10.8 +/- 2.2 to 6.8 +/- 2.2 mm Hg (p less than 0.01), and a decrease in cardiac index from 2.7 +/- 0.3 to 2.2 +/- 0.2 L/min/m2 (p less than 0.001) when the ventricular size was dropped from 50% to 25% of normal. The difference between mean pulmonary artery pressure and mean right atrial pressure, which reflects the positive stroke work index of the ventricle, disappeared once the right ventricular cavity was reduced to 25% of normal (15.0 +/- 6.1 versus 14.1 +/- 2.4 mm Hg; p = not significant). Experimental results were correlated with postoperative catheterization data from 19 patients with tricuspid atresia who had the Fontan operation. Mean right atrial pressure was 18 +/- 4.6 mm Hg and cardiac index was 2.35 +/- 0.65 L/min/m2 in patients with a direct atrium-pulmonary artery anastomosis or an atrioventricular anastomosis with a right ventricular cavity less than 30% of normal versus 13 +/- 3.2 mm Hg and 3.42 +/- 0.46 L/min/m2 for those with an atrioventricular connection and a right ventricular cavity greater than 30% of normal (p less than 0.05 and p less than 0.02, respectively). The right ventricle enlarged from 27% +/- 6% of normal preoperatively to 35% +/- 10% of normal on follow-up (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMed1988

Clinical and electrophysiologic features of fetal and neonatal paroxysmal atrial tachycardia resulting in congestive heart failure.

Those clinical and electrophysiologic features of paroxysmal atrial tachycardia (PAT) that appeared to be the cause of prenatal congestive heart failure (CHF) (hydrops fetalis) were evaluated in 12 neonates, ages 1 to 14 days, and compared with those occurring in 12 neonates, ages 2 to 34 days, who developed CHF from PAT diagnosed postnatally. Transesophageal electrophysiologic evaluation was performed after birth or at the time of PAT occurrence in the prenatal CHF group and at the time of CHF diagnosis in the postnatal CHF group. Before the electrophysiologic study, spontaneous PAT onset and termination were observed in all prenatal CHF neonates. In the postnatal CHF neonates, however, a single, prolonged episode of PAT was observed. During PAT, all neonates were observed to have a regular heart rate, normal QRS morphology and ventriculoatrial interval exceeding 80 ms. These findings suggested an orthodromic reciprocating tachycardia using an accessory atrioventricular connection as the tachycardia mechanism. In the 12 neonates with prenatal CHF, the PAT cycle length measured 243 +/- 30 ms, whereas in the 12 neonates with postnatal CHF it measured 208 +/- 19 ms (p less than 0.003). Neonates with prenatal CHF secondary to PAT appear to develop CHF from multiple PATs recurring at relatively long cycle lengths (slow heart rates), whereas postnatal CHF neonates develop heart failure symptoms during a sustained tachycardia episode with relatively short cycle lengths (fast heart rates).

Edema↗
PubMedDate not supplied

Reversible cardiomyopathy due to carnitine deficiency from renal tubular wasting.

The clinical course of a 4-month-old male infant with a dilated cardiomyopathy secondary to renal tubular losses of carnitine is outlined. He was admitted to the hospital with severe congestive heart failure. An echocardiogram demonstrated normal anatomy. The left ventricular shortening fraction measured 10%. A comprehensive cardiomyopathy evaluation was initiated. The total plasma carnitine level was only 25 mumol/ml, but the urine carnitine measured 434 nm/mg of creatinine. He was begun on oral L-carnitine and weaned from mechanical ventilation and inotropic support 10 days later. Two years later he remains asymptomatic with normal left ventricular function.

Cardiomyopathy, Dilated↗
PubMedDate not supplied

Pharmacodynamics and pharmacokinetics of esmolol, a short-acting beta-blocking agent, in children.

Esmolol, a short-acting intravenous cardioselective beta-blocking agent, was evaluated for age-dependent pharmacodynamic and pharmacokinetic features in 17 young patients (6 months to 14 years). A loading dose (500 micrograms/kg/min) alternating with a maintenance dose (25-200 micrograms/kg/min, titrating by 25 micrograms/kg/min every 4 min) was infused until the heart rate or mean arterial pressure decreased 10%. Cardiac index, left ventricular shortening fraction, and systemic vascular resistance were measured at baseline, peak esmolol effect, and recovery. Serum esmolol concentrations were obtained to determine the half-life and the elimination rate constant. Esmolol reduced the heart rate, blood pressure, shortening fraction, and cardiac index in all patients, but it did not change systemic vascular resistance. Maintenance esmolol dose was 118 +/- 49 micrograms/kg/min, and the half-life was 2.88 +/- 2.67 min. Blood pressure and heart rate returned to normal within 2-16 min, but cardiac index and shortening fraction took longer to recover. There were no statistically significant age-dependent pharmacodynamic effects, but blood pressure decreased prior to heart rate and cardiac index took longer to recovery in patients who weighed < or = 15 kg. The pharmacokinetic profile in young patients was similar to that of older patients, but the half-life was shorter. The only side effect was transient nausea and vomiting in one patient. Esmolol is a safe and efficacious beta-blocking agent in young patients.

Adolescent↗
PubMedDate not supplied

Iodixanol pharmacokinetics in children.

The objective of this report was to study the elimination pharmacokinetics of iodixanol in children. Iodixanol (Visipaque, Nycomed Inc., Wayne, PA, USA) is a new iso-osmolar iodinated radiocontrast agent. We hypothesized that elimination of this agent would be dependent on age-related differences in renal clearance. Seven centers enrolled 43 patients. Cardiac catheterization was performed in 41 patients and cranial computed tomography in 2. Patients were entered into 5 age groups: newborn to <2 months, 2 to <6 months, 6 months to <1 year, 1 to <3 years, and 3 to 6 months of age that is comparable to normal adults. Prolonged elimination in children <6 months of age is related to renal immaturity.

Age Factors↗
PubMedDate not supplied

Heart transplantation in neonates and in children.

Between May 1988 and July 1991, 28 neonates and children underwent orthotopic heart transplantation at Children's Memorial Hospital in Chicago. Indications for heart transplantation were hypoplastic left heart syndrome (10), dilated cardiomyopathy (13), aortic stenosis with endocardial fibroelastosis (1), complex D-transposition of the great arteries after Senning repair (1), L-transposition of the great arteries with single ventricle after shunt (1), cor biloculare, pulmonary atresia, and situs inversus after Fontan (1), and chronic rejection after heart transplantation for hypoplastic left heart syndrome (1). The age at time of transplantation ranged from 2 days to 17 years (mean, 5.3 +/- 6.1 years). Early deaths were from intraoperative donor right ventricular failure (2) and acute rejection after a second transplant procedure at 21 days (1), for an in-hospital mortality rate of 10.7%. Immunosuppression was with cyclosporine, azathioprine, and prednisone, with an attempt to discontinue the prednisone in neonates at age 6 months as guided by endomyocardial biopsy. Rejection episodes were treated with methylprednisolone pulse (34) or with OKT3 (4). Endomyocardial biopsy (in patients older than 6 months) was used extensively, and acute rejection was diagnosed in 29 of 301 biopsies. Three late deaths occurred (mean follow-up, 16.3 +/- 11.8 months): one of acute rejection at 13 months, one of viral pneumonia at 7 months, and one of intraabdominal sepsis as a complication of peritoneal dialysis at 5 months. Actuarial survival at 2 years is 77% +/- 9% (standard error of the estimate). Heart transplantation for neonates and for children can be performed with acceptable operative mortality. Intermediate results with triple therapy immunosuppression and an intensive rejection surveillance regimen relying on endomyocardial biopsy are encouraging.

Actuarial Analysis↗