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At least 883 records · Page 49Linked to original sources
PubMed1990

Long-term cardiopulmonary bypass by peripheral cannulation in a model of total heart failure. The decompression of the left heart through a percutaneous helical spring positioned within the lumen of the tricuspid and pulmonary artery valves.

We performed long-term closed-chest cardiopulmonary bypass in an animal model of total heart failure (induced ventricular fibrillation). The extracorporeal system included a venous reservoir, a roller pump, a membrane lung, and a blood pulsator system. We cannulated the right external jugular vein for venous drainage and the right subclavian artery for arterial return. To decompress the left heart we passed by percutaneous cannulation a special helical spring mounted on a Swan-Ganz catheter (Baxter Edwards Divisions, Irvine, Calif.) and positioned it to rest within the pulmonary artery and tricuspid valves, which rendered them partly incompetent. After induced ventricular fibrillation, blood flow was raised to keep the central venous pressure at baseline values. The lungs were ventilated with 5% carbon dioxide in room air. During bypass, mean pulmonary artery pressure was 10.0 +/- 1.7 mm Hg, mean wedge pressure 11.9 +/- 1.8 mm Hg, and mean blood pressure 95.2 +/- 5.6 mm Hg. After 2 days (four animals) and 3 days (two animals) the hearts were defibrillated. There was immediate ejection from both sides of the heart. All sheep were weaned from bypass within 29 +/- 11 minutes and their lungs were ventilated with room air within 42 +/- 34 minutes. At autopsy hearts and lungs grossly appeared normal. We conclude that the percutaneous helical spring resting within right heart valves provided excellent decompression throughout the study, with full recovery of heart and lung function on defibrillation.

Animals↗
PubMed1977

[Design and haemodynamic evaluation of the ellipsoid heart for total heart replacement].

Thromboembolism is a complication which represents a major limiting factor in animals with long-term postoperative survival periods following total artificial heart replacement. Thrombi are formed on the artificial valves, the biomaterials and in stagnation areas within the artificial ventricles. In design planning the stagnation areas should be avoided as well as major turbulences. The filling volume should be maximally used for the stroke volume and the epicenter of the membrane should be underneath the valve areas. The ellipsoid heart eliminates stagnation areas and the stroke volume is 82% of the filling volume. The maximum cardiac output is 15.8 l/min. The ellipsoid heart was implanted in 20 female calves; the maximum length of survival was 213 hours. There was no compression of the inferior vena cava and the heart fitted well into the chest of the animals. The cardiac output, self-regulated in the sense of Starling's law, was adequate to perfuse the animals and to allow moderate exercise such as standing. The arterial pressure curves show normal physiological activity. The curves in both atria are unphysiological, owing to relative insufficiency of the valves. The limiting factors were pulmonary insufficiency and surgical complications. The ventricles showed no thrombus formation -- except in one case, in which faulty material was the predisposing cause. It was possible to develop an automatic driving system on the basis of these experiments. Regulation occurred by means of gas flow control in the driving tubes, whereby the form of the gas flow curve provides information on position of the membrane. As soon as the membrane has reached the end-diastolic position, systole is triggered off and lasts until the end-systolic position is reached. If the venous return is increased, the ventricles are filled more rapidly and the heart is driven at a higher rate. One part of the ellipsoid heart is used as ventricle for assisted circulation. The left ventricle is cannulated via the left appendage or the apex. The ventricle relieves the left heart to a large extent and the cardiac output is taken over by the pump placed in a paracorporeal position. The blood is directed back into the thoracic aorta.

Animals↗
PubMed1989

[Clinical characteristics and prognostic factors in chronic heart failure secondary to primary dilated cardiomyopathy and ischemic heart disease].

Natural history and prognostic factors in chronic congestive heart failure were investigated in 141 patients (100 males and 41 females), aged 58 +/- 14.5 years, who were hospitalized between 1981-1985. Heart failure was due to idiopathic dilated cardiomyopathy in 79 patients and ischemic heart disease in 62 patients. The following parameters were examined: sex, age, etiology, NYHA functional class, mean arterial blood pressure, heart rate, presence of 3rd heart sound, atrial fibrillation and left ventricular conduction delay, plasma sodium, echocardiographic shortening fraction, and treatment with vasodilators. Mean follow-up was 31 +/- 19 months. Overall survival was 83% at 1 year, 58% at 3 years and 49% at 5 years. No difference in mortality was evident between the two etiological groups, while the data on the cause of death showed a significant difference: sudden death was prevalent in the patients with ischemic disease (50% vs 24%), intractable heart failure predominated in patients with idiopathic dilated cardiomyopathy (69.7% vs 42.8%) (p less than 0.05). The multivariate analysis with the Cox model resulted in a negative prognostic significance of the male sex (p less than 0.02), III and IV NYHA functional class (p less than 0.04), heart rate at rest greater than 85 b/min (p less than 0.002) and the presence of left ventricular conduction delay on standard ECG (p less than 0.001).

Adolescent↗
PubMed1979

[The ellipsoid heart. Construction and animal experimental findings of a new kind of artificial heart].

In order to avoid thrombi generation within artificial ventricles the Ellipsoid heart is built with a one-piece membran in enddiastolic position. This allows to have an optimal washout of all inside surfaces during the cardiac cycles, in enddiastolic position the cross sectional veiw of the membran is circle-shaped. 82% of the filling volume can be used for the maximal stroke volume, which is 120 ml. The maximal cardiac output is 16 l/min. The Ellipsoid heart is evaluated as design for total heart replacement and assisted circulation. As total artificial heart the survival times were in calves experiments up to 40 days, in assisted circulation in parakorporeal position up to 83 days. The cardiac assistance with the Ellipsoid heart (E-LVAD) is performed due to implanted canula in the left ventricle via the left atrium and a connection to the ascending aorta. This technique was applied in 14 clinical cases with cardiac failure after open surgery. The E-LVAD could support the failing heart; it could be removed in 4 patients. The aim to avoid thrombiformation within artificial ventricles could be achieved with the Ellipsoid heart in calve experiments as well as clinically--the membrane was constantly clean and free of any thrombidepositions.

Animals↗
PubMed1995

[Pathophysiology and treatment of congestive heart failure--recently advanced strategy for heart failure].

The principle functions of the heart are to accept blood from the systemic and the pulmonary circulatory system, pump and deliver it to the whole body tissues and lungs. The term "heart failure" is used to describe the pathophysiological state in which an abnormality of cardiac function is responsible for failure of the heart to pump blood at a rate commensurate with the requirements of the metabolizing tissues, or to do so only from an elevated filling pressure. Thus, for a long period, heart failure has been thought of as a mechanical disorder of the heart and vessels, and its treatment has been based on improving impaired cardiac function and hemodynamic disorder. Recently multi-center, randomized placebo-controlled survival trials revealed that pure inotropic agents such as phosphodiesterase inhibitors succeeded in mechanical improvement, yet not only failed to prolong the patient's life, but also increased mortality. A number of neurohumoral mechanisms, which are activated in heart failure, were thought to be compensatory ones. However, survival trials demonstrated that two types of drug interfering with the renin-angiotensin system and the sympathetic nervous system reduced mortality. Those drugs are angiotensin-converting enzyme (ACE) inhibitors and beta blockers. ACE inhibitors reduce the direct effects of angiotensin II on myocardial cells, which may lead to cell necrosis, imbalanced remodeling through fibrosis, and attenuate the progressive ventricular dilatation. Local tissue renin-angiotensin system may be potentially important in regulating the angiotensin II production in both heart and vessels.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Heart transplantation in Spain: the Spanish National Registry of Heart Transplantation (1984-1992).

The first heart transplantation in Spain was performed in 1984. Since then, 950 patients had undergone heart transplantation in our country as of December 1992. Data from all these 950 patients have been reported to the Spanish National Registry of Heart Transplantation since its inception in 1989. Follow-up is complete for all patients. Mean age of recipients was 46 +/- 14 years; 86% were male patients. Almost 50% of all heart transplant procedures were performed in 1991 (232 patients, 6 per million persons) and 1992 (254 patients, 6.6 per million). Twelve centers have performed heart transplantations in Spain. Of the 950 procedures, 907 (95%) have been orthotopic, 6 (0.6%) heterotopic, 16 (1.7%) heart-lung transplantations, and 21 (2.7%) retransplantations. Mortality on waiting list was 8% in 1991 and 5.2% in 1992. Idiopathic (47%) and ischemic (37%) cardiomyopathy were the two main causes leading to transplantation. Mean recipient age has increased from 38 years in 1985 to 50 in 1992; 50% of all patients who underwent transplantation in 1992 were older than 50 years of age, with 11% older than 60 years of age. Actuarial survival was 74% at 1 year and 63% at 6 years, which is similar to that of the International Society for Heart and Lung Transplantation Registry. One-year survival increased from 61% for patients receiving transplants in 1985 to 77% for those who received transplants in 1992. One-month mortality decreased from 23% in 1985 to 12% in 1992.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1996

Hearts from donors with chronic alcohol use: a possible risk factor for death after heart transplantation.

BACKGROUND: Careful donor and recipient selection are important factors for the success of heart transplantation. Currently, donors with a history of alcohol use are routinely accepted despite the potential deleterious effects of alcohol on the heart. METHODS: We examined the frequency of chronic alcohol use (> 2 ounces of pure alcohol daily for > or = 3 months) among organ donors and the outcome of the receipients after heart transplantation. Of 99 consecutive patients who underwent transplantation between December 1988 and August 1993 with an adequate donor history, 17 (17%) had a history of chronic alcohol use (alcohol group), and 82 (83%) did not (nonalcohol group). All recipients received triple-drug immunosuppression, and 10 to 14 days of OKT3. RESULTS: Survival rates at 1 and 2 years were significantly lower in the alcohol group (61% +/- 13% and 61$ +/- 13%) than in the nonalcohol group (95% +/- 3% and 91% +/-4%, p = 0.0001). Most deaths in the alcohol group occurred within 3 months after transplantation. The incidence of rejection episodes did not differ significantly. Fatal rejection occurred more frequently in the alcohol group and was associated with severe ventricular dysfunction before death. Cox multiple regression analysis identified donor alcohol use as an independent risk factor for death after heart transplantation. CONCLUSIONS: A substantial proportion (17%) of heart donors have a history of chronic alcohol use. The unfavorable early outcome of patients receiving hearts from alcoholic donors suggests the presence of a subclinical alcoholic cardiomyopathy before transplantation and poor tolerance of rejection episodes after transplantation. Larger prospective studies are needed to determine the mechanism of fatal rejection and whether such hearts can be used safely for transplantation.

Adolescent↗
PubMed1997

[Reevaluation of heart disease deaths on death certificates and trends for ischemic heart disease mortality during the last five years in Oita city].

To evaluate heart disease deaths and clarify trends for ischemic heart disease (IHD) mortality during the last five years in Oita City, we reevaluated causes of death on death certificates. In 1993, there were 253,000 people aged 25-74 in Oita City. In this population age group, there were 1,996 deaths from January 1992 through December 1993. Our subjects were 982 deaths recorded as caused by heart disease and IHD related diseases. Subjects were reevaluated on the basis of physician's interview, clinical records and police records. This IHD reevaluation was conducted by the WHO MONICA criteria. The death certificates identified 321 heart disease deaths, of which there were 80 (24.9%) acute myocardial infarctions (AMI), 22 (6.9%) other IHD, 180 (56.1%) heart failures, and 39 (12.1%) other heart diseases. The remaining 61 deaths were caused by other diseases. After reevaluation, 40 'definite' AMI and 60 'possible' AMI were recognized through the MONICA criteria, 86 sudden deaths (SD) which were defined as, 'death within 24 hours of the onset of acute symptoms and without clear signs suggesting what disease was the cause,' were also classified. Assuming that 50% of SD were due to IHD, according to some postmortem autopsy studies, aged-standardized IHD mortality per 100,000 for males was 38.3 per year and for females 17.3 per year in this period. Both mortality rates, 31% for males and 38% for females, were higher than IHD mortality statistics. Moreover, in comparison with IHD mortality estimated by reevaluation of heart disease in Oita City in 1987-88, age-standardized IHD mortality per 100,000 for males has remained basically stable, increasing from 37.8 to 38.4 during the last five years. On the other hand, mortality for females has increased from 11.2 to 17.3. Our results suggest that mortality from IHD actually was about 30% more than mortality statistics, and does not show a declining trend as mortality statistics have stated.

Adult↗
PubMed1997

Experience of patients with end-stage heart failure who underwent heart transplant at UCLA.

From 1993 to 1997, nine Japanese heart transplant candidates were accepted by the University of California at Los Angeles (UCLA) Medical Center, because no donor heart was available in Japan from a brain-dead patient. In all nine heart transplant patients described in this investigation, the preoperative diagnosis was dilated cardiomyopathy. One patient underwent implantation with a Novacor left ventricular assist device (Baxter Japan, Tokyo, Japan) as a bridge to heart transplant. All patients survived surgery and for a long-term period. The actuarial 1-year and 3-year survival curves of these patients were both 100%. The postoperative functional status was New York Heart Association Class 1 in all patients (100%). Immunosuppressive triple drug therapy (azathioprine, steroids, and cyclosporine) was given in seven patients; in two patients, cyclosporine was withdrawn and replaced by FK506 due to refractory rejection. The incidence of acute rejection per patient of more than grade 3 according to the International Society for Heart and Lung Transplantation was 6% within 3 months and 4.5% in 3-6 months; there was no rejection episode more than 6 months after transplantation. Post-transplant coronary artery disease was seen in two patients. However, no disease progression was seen after diltiazem therapy. These results may encourage heart transplantation in Japan.

Adult↗
PubMed1983

Congestive heart failure in valvular heart disease in pregnancies with and without valvular prostheses and anticoagulant therapy.

The course and complications of pregnancies in 46 patients with valvular disease and congestive heart failure with or without valve prostheses are described. In group I consisting of 33 women without valve replacement and without anticoagulant therapy one thromboembolic event was seen, emergency closed or open heart surgery was necessary five times. One still-birth happened after open heart surgery. In group II, of 13 patients with prosthetic valve replacement and anticoagulation therapy there was no thromboembolism, but 2 spontaneous abortions and 2 premature stillbirths; 2 fetuses died after delivery, 3 had congenital abnormalities. Pregnancies in patients with valvular disease and congestive heart failure can be sustained relatively safely for the mother, even if emergency heart surgery becomes necessary. Heart surgery and anticoagulation treatment carry a higher risk for the fetus. Uterine blood loss is not increased, if coumadine treatment is switched to heparin administration shortly before delivery.

Abnormalities, Drug-Induced↗
PubMed1991

[Therapy of terminal heart failure using heart transplantation].

Heart transplantation (HTx) has now become an accepted treatment modality for end-stage heart disease. The limited supply of suitable donor organs imposes constraints upon the decision of who should be selected for transplantation. Usually patients are candidates for HTx, who remain NYHA functional class III or IV despite maximal medical therapy. Further criteria are low left ventricular ejection fraction (less than 20%) with heart rhythm disturbances class IIIA-V (LOWN), which are associated with poor prognosis. Additionally, the suffering of the patient and also the course of heart failure are essential for judging the urgency of HTx. Contraindications are absolute in patients with untreated infections, fixed pulmonary vascular resistance (PVR) above 8 WOOD-degrees, severe irreversible kidney and liver disease, active ventricular or duodenal ulcers and acute, psychiatric illness. HTx is relatively contraindicated in patients with diabetes mellitus, age over 60 years, PVR above 6 WOOD-degrees and an unstable psychosocial situation. To prevent rejection of the transplant heart, live-long immunosuppressive therapy is needed. Most immunosuppressive regimes consist of Cyclosporine A and Azathioprine (double drug therapy) or in combination (tripple drug therapy) with Prednisolone. For monitoring of this therapy, control of hole blood cyclosporine A level and white blood count is needed. Rejection episodes can be suspected if there is a greater than 20 mmHg decrease of systolic blood pressure, elevated body temperature, malaise, tachycardia or heart rhythm disturbance. The diagnosis of cardiac rejection can be established by endomyocardial biopsy. Measurement of the voltage of either the surface or intramyocardial ECG, echocardiography with special consideration to early left ventricular filling time as well as immunological methods are additionally used tools. Graft sclerosis as the main risk factor of the late transplant period remains an unsolved problem.

Adaptation, Psychological↗
PubMedDate not supplied

Quantitation of the global right ventricular function in children with normal heart and congenital heart disease: a right ventricular myocardial performance index.

Although the assessment of right ventricular (RV) function is important in the clinical management of children with congenital heart disease, available imaging techniques have been limited because of the complex geometry of the right ventricle. A new Doppler index combining systolic and diastolic time intervals (the Tei index) has been reported to be useful for the assessment of global RV function in adults. However, normal values in children, age-related changes, and the clinical utility of the Tei index with regard to congenital heart disease have not been demonstrated. The purpose of this study was to prospectively assess RV function in children with normal heart and congenital heart disease using the Tei index. The subjects included 150 healthy children and 43 patients with congenital heart disease (35 patients with atrial septal defects and 8 patients who had had a Senning operation). The index was defined as the sum of isovolumetric contraction time and isovolumetric relaxation time divided by ejection time and was measured from conventional RV outflow and inflow Doppler velocity profiles. The Tei index was not affected by age in healthy children (0.24 +/- 0.04). There was a significant difference in index rating between patients who had had a Senning operation (0.58 +/- 0.09) and healthy children (p < 0.01), but there was no significant difference between children with atrial septal defect (0.25 +/- 0.13) and healthy children. The Tei index is a feasible approach to use when assessing global RV function in children with congenital heart disease.

Adolescent↗
PubMed2004

[Studies on morphogenesis and visualization of the early embryonic heart with regard to the development of conotruncal heart defects].

Most congenital cardiovascular malformations have their origins during early morphogenesis, and some forms of adult-onset cardiovascular disease also arise during embryonic development. Conotruncal heart defects comprise a major category of congenital heart disease and are found in children with a relative high frequency. These defects are associated with a high mortality risk in utero, and after postnatal surgical repair; embryologically they are linked with dextroposed aorta, which is an anomaly of the ventricular outflow tract with malalignment of the great arteries. The etiology and pathogenesis of dextroposed aorta is not known but is thought to be due to abnormal looping and/or incorrect "wedging" of the outflow tract (i.e., wedged positioning of the aorta between the atrioventricular valves) during early heart development. We have studied the morphology and visual development of the embryonic heart in an animal model of dextropsed aorta in a series of experiments to determine possible mechanisms for dextropositioning of the aorta. At this, we have employed besides established methods for analysis of anatomy and pathology (morphological studies, cardiac morphometry, histology, scanning electron microscopy and immunhistochemistry) also new imaging techniques (videocinephotography and time-lapse studies with a digital high-speed video camera, confocal and scanning electron microscopy, optical coherence tomography (OCT) and magnetic resonance microscopy (MRM) for 3D reconstruction of the heart) to achieve a better visualization of normal and pathological changes during heart development. The paper at hand summarizes the results of these studies.

Adult↗
PubMed1990

Regulation of the mitochondrial adenosine 5'-triphosphatase in situ during ischemia and in vitro in intact and sonicated mitochondria from slow and fast heart-rate hearts.

In the present study we examined the regulation of the cardiac muscle mitochondrial ATPase both in situ and in vitro in intact and sonicated mitochondria from rabbit, pigeon, and rat. We chose to study these three species because each is representative of one of the three classes into which all species thus far studied may be placed with respect to the in situ activity of their cardiac muscle mitochondrial ATPase inhibitor and with respect to the amount of ATPase inhibitor present in their cardiac muscle mitochondria (1). Class A species (rabbit) contain a full complement of ATPase inhibitor and show a marked ATPase inhibition during ischemia. Class B species (pigeon) also contain a full complement of inhibitor but exhibit only a low level of ATPase inhibition in situ. Class C species (rat) contain only low levels of inhibitor and, like class B species, don't appear to utilize the inhibitor they possess during ischemia in situ. We found that, while hearts from all three species developed a marked cytosolic acidosis during ischemia, only rabbit exhibited a marked ATPase inhibition in situ. In in vitro experiments in which matrix pH values close to 6.2 and delta psi values close to zero were measured in intact mitochondria from all three species, matrix pH appeared to be an important factor regulating ATPase inhibition in rabbit, but it had little effect upon ATPase--inhibitor interaction in pigeon and rat despite the lack of membrane potential. However, a pH-dependent further release of ATPase inhibitor was observed in sonicated pigeon heart mitochondria only. This latter observation suggests that, while slow heart-rate heart mitochondria appear to be designed for ATPase down regulation during ischemia by inhibitor binding to the ATPase, fast heart-rate heart mitochondria appear to be designed primarily for ATPase up regulation by a further release of inhibitor from the enzyme.

Adenosine Triphosphatases↗
PubMed1988

Spectral analysis of heart rate variability following human heart transplantation: evidence for functional reinnervation.

To determine the status of innervation in long-term human donor allografts, the power spectrum of heart rate variability was analysed in 9 post-transplant patients and 7 healthy control subjects. The mean post-transplant follow-up was 17.8 months (range: 2-37 months). Continuous ECG signals were recorded throughout a 15-min rest period. An R-R interval tachogram was generated and an autoregressive model using linear predictive coding, was applied to the heart rate variability data. In 8 transplant patients the frequency oscillations were irregular, broad based and widely dispersed from 0 to 1 Hz. The patterns resembled white noise and were consistent with dissociation of the donor allograft from the recipient's central nervous system. In contrast, one patient displayed a heart rate variability spectrum indistinguishable from that of control subjects. This pattern contained two distinct spectral bands; one corresponding to the patient's respiratory rate at 0.2 Hz and a low frequency Mayer wave at 0.1 Hz. Atropine abolished the respiratory (vagal) peak. Except for this patient's post-transplant time (33 months compared to the group mean of 17.6 months), there were no clinical characteristics which distinguished this patient from the others. While the mean heart rate for the remaining 8 allografts was significantly higher than controls (95.3 vs 64.5 bt/min; P less than 0.001) the standard deviation of heart rate variability for the 8 patients was significantly narrower than controls (0.7 vs 4.86; P less than 0.01). The variance of heart rate for the patient with the normal power spectrum was fourfold greater than the mean SD of the other transplant patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Sympathetic reinnervation after heart transplantation, assessed by iodine-123 metaiodobenzylguanidine imaging, and heart rate variability.

OBJECTIVE: Complete allograft denervation occurs during heart transplantation. Partial ventricular sympathetic reinnervation may develop one year or later after transplantation and can be measured with iodine-123-meta-iodobenziylguanidine (MIBG) uptake. Aim of this study was to assess sinus node sympathetic reinnervation measured with heart rate variability and ventricular sympathetic reinnervation evaluated with MIBG. METHODS: Twelve patients and 14 healthy controls were included. In patients, MIBG scintigraphy with early and late imaging was performed. Heart to mediastinum ratio (HMR) was calculated and patients were divided in groups with (HMR>1.3) and without left ventricular reinnervation (HMR<1.3). Bipolar ECG with high sampling rate and resolution was recorded over 8.5 min in supine position and in upright position after 10 min interval. R-R intervals in time domain and heart rate variability in frequency domain through spectral power analysis of R-R intervals were analysed to evaluate sinus node reinnervation. Spectral power in low frequency range (0.04-0.15 Hz) above 4.5 ms(2) was considered as sinus node sympathetic reinnervation. RESULTS: Six (50%) patients had evidence of left ventricular sympathetic reinnervation on scintigraphy. Sinus node sympathetic reinnervation based on heart rate variability was detected in 6 (50%) patients in supine, and in 4 (33%) patients in upright body position. Four patients groups were discerned: (1) with ventricular and sinus node sympathetic reinnervation, (2) with sinus node sympathetic reinnervation, (3) with ventricular sympathetic reinnervation and (4) without atrial or ventricular sympathetic reinnervation. Ventricular reinnervation process was time dependent and sinus node reinnervation was not. CONCLUSIONS: Simultaneous ventricular sympathetic reinnervation assessed by MIBG and sinus node sympathetic reinnervation assessed by heart rate variability in supine as in upright position were detected only in two patients (17%). The results of our study show that eventual sinus node sympathetic reinnervation and left ventricular sympathetic reinnervation do not occur simultaneously.

3-Iodobenzylguanidine↗
PubMed2006

Longitudinal assessment of psychological functioning in children after heart or heart-lung transplantation.

BACKGROUND: Despite the increasing numbers of pediatric heart and lung transplants being performed worldwide, longitudinal psychological evaluation of children and adolescents undergoing transplantation remains uncommon. The objective of this study was to assess psychological functioning in a group of patients at 12 months and 3 years after transplantation. METHODS: Thirty-four children and adolescents (mean age at 12-month assessment: 7.9 years [range 1.3 to 15.3 years]) were evaluated after heart (n = 24) or heart-lung (n = 10) transplantation for congenital heart disease (CHD; n = 10), cystic fibrosis (n = 1), cardiomyopathy (CM; n = 21) or primary pulmonary hypertension (n = 2). Standardized measures were used to assess development, cognitive function, mood state and behavior at each test occasion. RESULTS: Measures of developmental, cognitive and academic function were within the normal range with each test and showed stability over time. About 33% of patients had behavior problems at each test occasion, which is higher than the 10% reported for the normal population, but the prevalence of depression fell from 23% at 12 months to 13% at 3 years. Although there were no significant differences between heart and heart-lung recipients, children with a pre-transplant diagnosis of CHD had poorer scores on cognitive and behavioral parameters than those with CM. In particular, while the prevalence of behavior problems showed a slight decrease over time in the CM group, it increased from 33% at 12 months to 75% at 3 years in the CHD group. CONCLUSIONS: A number of pediatric patients continue to have psychological difficulties 3 years after transplant. Initial diagnosis is an important factor in post-transplant psychological functioning, with a diagnosis of CHD appearing to be a risk factor for greater psychological morbidity, at least in the short and medium term. Further follow-up must address whether such differences persist in the longer term. Patients at risk for poorer psychological outcome need to be identified so that interventions can be implemented to reduce psychological morbidity.

Adaptation, Physiological↗
PubMed1996

Reinnervation of the transplanted human heart as evidenced from heart rate variability studies.

This study evaluated heart rate variability (HRV) after cardiac transplantation in humans in an attempt to test the hypothesis that cardiac reinnervation occurs in the post-transplant period. HRV was measured using 24-hour Holter recordings performed on 37 ambulant patients 1 to 122 months after cardiac transplantation. All patients were free of histologic rejection and were taking no medication likely to influence HRV. Time and frequency domain were analyzed and circadian rhythm of hourly average heart rate was calculated. HRV increased with time after the transplant. Compared with patients in the early post-transplant period, patients > 36 months after transplant had lower 24-hour heart rates (86 vs 93 beats/min), an increased average of all 5-minute SDs of NN intervals (17.6 vs 11.3), and higher low-and high-frequency power. Ten of the 27 patients > 3 years after transplantation had evidence of functional cardiac reinnervation. Compared with patients who had no reinnervation, these patients had increased circadian variability with lower nocturnal heart rates (76 vs 91 beats/min) and greater sympathetic activity during daytime (natural logarithm sympathetic power -0.36 vs -1.45) and nighttime (natural logarithm sympathetic power -0.43 vs -1.98). Despite lower nocturnal heart rates, there was no HRV evidence for an increase in parasympathetic activity. Thus, patients late after cardiac transplantation have HRV evidence for an increase in sympathetic control of the heart.

Adult↗