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PubMedDate not supplied

Differences in left ventricular filling patterns in heart and heart-lung transplant recipients as assessed by Doppler echocardiography of transmitral flow.

The conventional surgical technique of orthotopic heart transplantation involves reconstruction of atria from donor and recipient components. The mechanical function of the atria is thus likely to be altered either by this anatomic disruption or by the autonomic denervation, which also occurs as a result of transplantation. We investigated 18 subjects with Doppler echocardiography of transmitral flow, to assess the contributions of passive and active filling of the left ventricle in six normal subjects, six heart transplant recipients, and six heart-lung transplant recipients. The ratio of passive transmitral flow to active flow was significantly higher in isolated heart transplant recipients than in normal subjects (p < 0.001), suggesting a reduced active, late diastolic component to left ventricular filling. This was not due to denervation, because the ratio in heart-lung recipients was lower than that in normal subjects (p < 0.01). These data suggest that anatomic rather than neural dysfunction is responsible for a major change in transmitral flow characteristics after isolated heart transplantation; whether the resulting change in pattern of left ventricular filling is clinically important deserves further investigation.

Blood Flow Velocity↗

PubMed2003

[Cardiopulmonary exercise test and heart rate variability in patients with congestive heart failure who underwent physical rehabilitation].

Physical rehabilitation of patients with heart diseases is a well-known therapeutical method used in patients with heart failure. However there is no consensus regarding rehabilitation program for these patients. The aim of this study was to assess tolerance of physical exercise and parameters of heart rate variability in patients with chronic heart failure who were exercised using different models of training. 42 patients (mean age 55.9 +/- 8.2) with chronic heart failure (NYHA class II and III) were included into this study. They were divided randomly into three groups, each number 14 patients: group A--patients who were trained according to model with progressive increase of workload, group B--patients with interval training, and group C--patients who were not trained at all. The study groups did not differ in average age, BMI, NYHA class, or pharmacological treatment. All patients from groups A and B were rehabilitated during six months, 3 times per week for 1.0 hour each time. All patients were submitted to the following examinations before and after six months of training: echocardiography, cardiopulmonary exercise test and 24-hour ECG recording with evaluation of time-domain HRV parameters. In groups A and B we observed an improvement in exercise capacity, which was more pronounced in group A. This improvement was observed as increase in total exercise time when compared with group B and C (839.1 +/- 98.3 sec vs 472.4 +/- 39.7 sec vs 347.92 +/- 61.0 sec respectively at p < 0.0001), and increase in workload (6.28 +/- 0.8 MET vs 3.9 +/- 0.2 MET vs 2.6 +/- 0.63 MET respectively in the study groups). We also found improved cardiopulmonary exercise test. After six months we observed significant differences in all parameters between group A and C, and in VO2max between group B and C (16.5 +/- 1.9 vs 14.1 +/- 1.9 ml/kg/min, p < 0.01) and in VE/VCO2 (37.8 +/- 4.2 vs 40.4 +/- 6.7 l/min, p < 0.01). After 6 months we also found significant differences between group A and B in HRV parameters which reflect total activity of the autonomous system (SDNN--174.0 vs 96.0 at p < 0.0001; SDANNI--138.1 vs 83.2 at p < 0.0001) and between group A and group C (174.0 vs 78.4, p < 0.0001). In parameters that reflect parasympathetical activity of the autonomous system there were significant changes between group A and group B (rMSSD--42.5 vs 24.7 at p < 0.001, pNN50 18.5 vs 4.2, p < 0.001) and between group A and group C (rMSSD--42.5 vs 16.7 at p < 0.001, pNN50 18.5 vs 4.2 at p < 0.001). Regular exercise training in patients with chronic heart failure, using especially the progressive increase of workload, improves exercise capacity without any negative influence on systolic and diastolic function parameters of the left ventricle. In these patients we may also observe beneficial changes in HRV parameters.

Adult↗

PubMed2004

[Cardiac rehabilitation in patients with a congenital heart disease, an implantable cardioverter defibrillator or chronic heart failure].

Cardiac rehabilitation is no longer just used to treat patients after the manifestation of a coronary artery disease such as a myocardial infarct, after a PTCA or after a coronary bypass operation. Patients with a congenital heart disease, patients who have received an implantable cardioverter defibrillator (ICD) and patients with stable chronic heart failure are also suitable candidates for a multidisciplinary cardiac rehabilitation programme. The new Dutch guidelines for cardiac rehabilitation, published in 2004, can be helpful in identifying potential candidates for a programme. Physical training is often a component of the treatment, but psycho-social counselling and education targeted at reducing anxiety and uncertainty, accepting the heart disease and learning to cope with it, can be just as important as those aspects targeted at improving the physical condition. Cardiac rehabilitation that includes physical training is safe for patients with congenital heart disease, for patients who have undergone an ICD implantation and for patients with stable chronic heart failure, as long as the pretraining exercise test is given a guiding role in selecting the appropriate physical work load. Patients with stable chronic heart failure should continue their physical training in order to maintain its beneficial physical and psychological effects.

Defibrillators, Implantable↗

PubMed2006

[Prognostic value of symptoms and signs of advanced heart failure and low left ventricle ejection fraction in patients after myocardial infarction with chronic heart failure].

INTRODUCTION: Prognosis in patients (pts) after myocardial infarction (MI) with chronic heart failure (CHF) and asymptomatic left ventricular dysfunction (ALVD) differs. Acute coronary syndromes (ACS) worsen CHF and prognosis in these pts. A diagnostic tool that identifies the group of high risk pts is needed. Prognostic factors include left ventricle ejection fraction (LVEF) and stage of heart failure. The aim of the study was evaluation if decreased LVEF worsen prognosis in pts with CHF and ALVD and whether LVEF is more powerful predictor of poor prognosis than severity of heart failure. MATERIAL AND METHODS: 112 consecutive pts (95 men and 17 women age range 34-75, mean 52.9) post MI in stage B (ALVD) or stage C (CHF) according to ACC/AHA classification were studied. LVEF was determined in standard echocardiography with Simpson's method. Pts were divided into four groups: I--stage B and LVEF < or = 40% (6 pts); II--stage B and LVEF > 40% (52 pts); III--stage C and LVEF < or = 40% (19 pts); IV--stage C and LVEF > 40% (35 pts). The pts were followed for 30 months for the occurrence of the composite endpoint: major acute coronary events (MACE) i.e: ACS and cardiovascular deaths (CVD). In analysis we used chi2 test. RESULTS: There were 35 MACE during follow-up: 30 in pts in stage C and 5 in stage B. There were more MACE in group I than in group III (p < 0.01) and in group II than in group IV (p < 0.001). Pts in group I had more MACE than in group IV (p < 0.05). There were more MACE in group II than in group III (p < 0.01). Other results were not statistically significant. CONCLUSIONS: Stage of heart failure evaluated clinically is more powerful predictor of MACE than decreased LVEF. The more advanced stage of heart failure in post-MI pts, the higher risk of ACS or CVD. LVEF does not influence the risk of MACE in pts in the same stage of heart failure.

Adult↗

PubMed2006

QT dispersion and heart rate variability in sudden death risk stratification in patients with ischemic heart disease.

The aim of the article is to review the literature data about the significance and problems of the QT dispersion and heart rate variability in sudden death risk stratification in patients with coronary heart disease. QT dispersion is defined as the difference between the longest and the shortest QT intervals as measured in the 12-lead electrocardiogram. A direct relationship between the prolongation of QT dispersion and myocardial ischemia has been reported by several authors. Our previous study showed that QT dispersion assessed immediately after bicycle exercise test was significantly higher in patients with coronary stenoses of > 50% as compared to the patients without coronary artery disease. Despite some controversial data, several studies showed that QT dispersion is a significant predictor of cardiovascular mortality. Heart rate variability representing a relationship between the autonomic nervous system and cardiovascular mortality, including sudden cardiac death, is one of the most promising markers. The predictive value of heart rate variability is independent of other factors established for postinfarction risk stratification, such as depressed left ventricular ejection fraction, increased ventricular ectopic activity, and presence of late potentials. For prediction of all-cause mortality, the value of heart rate variability is similar to that of left ventricular ejection fraction, but heart rate variability is superior to left ventricular ejection fraction in predicting arrhythmic events (sudden cardiac death and ventricular tachycardia).

Cardiotonic Agents↗

PubMed2006

[Diagnostic value of the currently used criteria and brain natriuretic peptide for diagnosing congestive heart failure in children with congenital heart disease].

OBJECTIVE: To improve the accuracy of diagnosis of heart failure (HF) has been the focus of research for a long time. The diagnosis for HF with congenital heart disease, however, is more difficult. The aim of the study was to evaluate the diagnostic criteria for HF in children and examine the value of plasma brain natriuretic peptide (BNP) and NT-proBNP for diagnosing HF in pediatric patients with congenital heart disease, and to look for the most valuable index for the diagnosis according to the multifactor analysis. METHODS: Totally 118 children with congenital heart disease were enrolled. They were diagnosed using modified Ross score, Qingdao criteria, NYU PHFI, and plasma BNP and NT-proBNP. According to modified Ross score as the referent criteria, other diagnostic criteria and plasma BNP and NT-proBNP were studied. The sensitivity, specificity and area of the ROC curve were examined. Logistic regression analysis was used to select the valuable index for diagnosing HF. RESULTS: (1) The value of each clinical criteria: 1 The sensitivity of Qingdao criteria for diagnosing HF was 47.9%. The specificity was 100% and the accuracy was 57.6%. 2 There were 52 patients younger than six months in whom 27 (51.9%) were breast fed. Only 25 children were measured with Ross score. The Ross score was positively correlated with the modified Ross score (r = 0.948). The area under the ROC curve of Ross score diagnosing HF was 0.985, and the sensitivity was 88%, while the specificity was 100%. 3 NYU PHFI score was positively correlated with the modified Ross score. The area under the ROC curve of the NYU PHFI diagnosing HF was 0.964, and the sum of sensitivity and specificity was favorite when > or = 8 was set as the cut-off point. If > 2 was set as cut-off point, it had a high sensitivity but a low specificity. The sensitivity of NYU PHFI was 100% > was set 2 as cut-point for diagnosing HF, but the specificity was 4.5%. (2) Plasma BNP and NT-proBNP were positively correlated with the modified Ross score, and increased with the severity of congestive HF. The area under the ROC curve of BNP was 0.880, and the cut-off line was > or = 349 pg/ml. The area under the ROC curve of NT-proBNP was 0.981, and the cut-off line was > or = 499 fmol/ml. (3) Logistic regression analysis showed that in multifactor analysis, only plasma concentration of NT-proBNP, dyspnea, tachycardia, tachypnea, failure to thrive were the independent predictors for diagnosing HF. (4) Plasma concentration of NT-proBNP incorporated with clinical criteria would improve its accuracy. CONCLUSION: All the clinical criteria commonly used were valuable for diagnosing HF in children with congenital heart disease, but each has its own limits, such as the low sensitivity of Qingdao, the low adaptation of Ross score because of the high breast-feeding rate in our country and the low specificity of NYU PHFI when > 2 was set as the cut-off point. Plasma concentrations of BNP and NT-proBNP were valuable for diagnosing HF in children with congenital heart disease, and NT-proBNP was the independent predictor for HF.

Adolescent↗

PubMed1990

Heart and heart-lung transplantation at the Johns Hopkins Hospital.

Since 1983, 120 patients have undergone heart transplantation and 18 patients have had heart-lung transplants at our institution. Transplantation is limited only by donor referrals but relaxation of donor criteria has increased donor availability. Immunosuppression currently consists of a 3-drug protocol of CsA, Aza, and P. Our current 1- and 5-year survival rates for heart transplants are 85% and 66%, respectively. The 1-year survival for heart-lung transplantation is 53%. Research continues in many areas of transplantation. The development of coronary artery disease in grafted hearts remains a problem. We have found that older donor age and Cmv infection are significant predictors of developing coronary disease. Routine successful extended heart-lung preservation has been difficult to achieve. A successful technique of prolonged preservation would allow for better matching, reduced logistics, and, potentially, increased numbers of donor organs.

Age Factors↗

PubMedDate not supplied

Heart-lung transplantation for cystic fibrosis and subsequent domino heart transplantation.

Between September 1984 and October 1988, 27 patients underwent combined heart-lung transplantation for treatment of end-stage respiratory disease caused by cystic fibrosis. The actuarial patient survival was 78% at 1 year and 72% at 2 years. Bacterial respiratory infections were common in the early postoperative period and necessitated vigorous medical therapy. The dose of cyclosporine required in these patients was higher than in conventional transplant recipients, and this contributed to an increased cost of postoperative care. Lung function was greatly improved after transplantation, and long-term survivors achieved an excellent quality of life. Lymphoproliferative disorders developed in two patients; these disorders regressed after a reduction in immunosuppression. Two patients required retransplantation: one because of obliterative bronchiolitis and the other because of recurrent respiratory infections associated with a moderate tracheal stenosis and severe deterioration in lung function. A modification of the technique used for heart-lung transplantation allowed 20 hearts from cystic fibrosis patients to be used for subsequent heart transplantation. Immediate heart function was satisfactory in all cases. The actuarial survival of the recipients of these domino heart transplants was 75% at 1 year. No coronary artery disease was present in the 12 patients who have undergone coronary angiography at 1 year.

Actuarial Analysis↗

PubMed1985

General surgical complications in heart and heart-lung transplantation.

One hundred forty-three patients underwent cardiac transplantation from 1980 to 1985; 122 received a heart, 19 received a heart-lung, and two received a heart-liver transplant. All patients received immunosuppression with prednisone and cyclosporine. General surgical complications have developed since transplantation in 40 patients (28%). Of these, 17 patients have required surgery: exploratory laparotomy (10 patients), inguinal or ventral herniorrhaphy (two patients), repair of false aneurysm of the femoral artery (two patients), repair of lymphocele of the groin (two patients), and incision and drainage of a perirectal abscess (one patient). Of the 10 patients who required laparotomy, three underwent sigmoid resection for a perforated sigmoid diverticulum (all survived), two underwent small bowel resection for perforation (both died), two had free intraperitoneal air with no site of perforation found (one died), one underwent a cholecystostomy and one a cholecystectomy for acute calculous cholecystitis (one died), and one underwent an elective pyloroplasty for gastric outlet obstruction secondary to vagus nerve injury during heart-lung transplantation and survived. All patients who underwent elective surgery survived. Six patients died without operation and at autopsy were found to have unrecognized general surgical complications including pancreatitis (three patients), cecal ulceration with sepsis (two patients), and jejunal perforation secondary to peritoneal dialysis (one patient). Eleven other patients had severe abdominal pain and five had gastrointestinal hemorrhage not requiring operation. Proper management of these patients includes early and aggressive diagnosis of conditions requiring operative intervention, strict attention to surgical technique, and careful titration of dose of immunosuppressive drugs. The 28% incidence of general surgical complications associated with heart and heart-lung transplantation emphasizes the role of the general surgeon in the management of these complex patients.

Adolescent↗

PubMed1984

Effects of reperfusion after acute coronary occlusion on the beating, working heart compared to the arrested heart treated locally and globally with cardioplegia.

To determine whether acutely ischemic myocardium could be more effectively salvaged by reperfusion on cardiopulmonary bypass (CPB) in the cardioplegia-treated heart than with reperfusion in the beating, working heart, 52 greyhound dogs underwent 3 hours of left anterior descending (LAD) occlusion and were randomly assigned to one of four groups. In Group I (19 dogs) the LAD occlusion was released at 3 hours and reperfusion continued in the beating, working heart for an additional 3 hours. Group II (six dogs), Group III (14 dogs), and Group IV (13 dogs) were placed on CPB and underwent 45 minutes of hypothermic ischemic arrest protected by aortic root potassium cardioplegia. In Group II, only aortic root potassium cardioplegia was given; in Group III, the ischemic area was perfused with potassium cardioplegic solution via a graft from the internal mammary artery (IMA) to the LAD. In Group IV, blood cardioplegic solution via the IMA-LAD graft was used. After the cross-clamp and local occlusion were removed, CPB was discontinued after an additional 45 minutes and reperfusion was continued off CPB for an additional 1 1/2 hours (total 6 hours). The ischemic area at risk was determined by injecting monastryl blue dye via the left atrium while the LAD was briefly reoccluded. After the animal had been sacrificed and the left ventricle had been sectioned, the area of myocardial necrosis was determined by nonstaining with triphenyltetrazolium chloride (TTC). For each group, the ratios of area of necrosis/area at risk (AN/AR) were calculated and postreperfusion arrhythmias were documented. Postreperfusion arrhythmias were noted in 11 of 12 animals in the beating, working heart group and only two of 24 in the combined CPB groups. The mean AN/AR was 66% +/- 2% in the beating, working heart (Group I), 59% +/- 6% after infusion of potassium cardioplegic solution into the aortic root (Group II), 57% +/- 6% with blood cardioplegia (Group IV), and 38% +/- 6.5% after global and local application of the potassium cardioplegic solution into the ischemic area (Group III). This study suggests that the reperfused ischemic myocardium will sustain less necrosis and less postreperfusion arrhythmias when the heart is protected by global and local cold potassium cardioplegia on CPB.

Acute Disease↗

PubMed1978

Studies on heart failure in old age (Part II). Hemodynamic effects of propranolol and isoproterenol in elderly patients with heart failure.

Hemodynamic responses to propranolol and isoproterenol were examined in elderly patients with heart failure. The results obtained are as follows: 1. Patients with mild heart failure showed greater reduction than control group in heart rate and cardiac output after intravenous propranolol. These enhanced hemodynamic responses to propranolol would be the evidence of increased adrenergic activity even in mild heart failure. 2. Intravenous propranolol in the small dosage of 0.03 mg/kg showed only a negligible hemodynamic deterioration even in patients with heart failure. 3. Hemodynamic responses to beta-adrenergic stimulator, isoproterenol, were depressed in severe heart failure.

Aged↗

PubMed1981

[Heart replacement (biventricular assisted circulation) with the ellipsoid heart (E-BVAD) (author's transl)].

At the present time mechanical assisted circulation is indicated in patients with cardiac failure after open heart operations. The results after clinical implantation of the left ventricular assist devices are not encouraging. However, most of these patients suffer from irreversible cardiac failure and no restitution is to be expected. In patients with postoperative cardiac failure, a distinction must be made between isolated left heart failure and total heart failure. In patients with total heart failure - for example with diffuse, marked coronary sclerosis - both left and right ventricle failure exists. In these patients, no left ventricular assist device per se can bring the desired effect, since due to the right heart failure syndrome, the left system does not work adequately. With the biventricular bypass it is possible to maintain complete circulation in cases of cardiac insufficiency. The cannulation concept is biventricular transatrial to the aorta or to the pulmonary artery. The technique is simple and can be carried out very quickly. In cases of clinical emergency this device can be recommended due to the satisfactory haemodynamic effects achieved and the small degree of traumatic haemolysis. It represents an easy and quick implantable system for total functional heart replacement.

Animals↗

PubMed1995

A comparison of the effects of rapamycin and cyclosporine on kidney and heart morphology in a rabbit heterotopic heart transplant model.

Rapamycin (RAPA) or cyclosporine (CsA) was administered intravenously, daily for 60 days, to rabbits with heterotopic heart transplants. Groups of 5 rabbits were randomly assigned to receive RAPA at 0.05, 0.1, 0.5 or 1.0 mg/kg/day or CsA at either 5.0, 10.0 or 15 mg/kg/day. Drug vehicle and saline controls were also included. Animals were examined daily and the cervical allografts assessed by palpation for viability/rejection. In those animals in which the heart stopped beating, the heart was removed and processed for light microscopic evaluation. The duration of the study was for 60 days at which time the animals were sacrificed and the transplanted heart and native kidneys removed and processed for light microscopic assessment of rejection and drug toxicity respectively. Biochemical and functional parameters in these animals were previously reported (Transplantation 5: 340-345, 1993). Animals that rejected their grafts were maintained on the drug until the endpoint of the study to assess toxicity in the native kidneys. The rejected hearts from these animals were also harvested for microscopic evaluation. The results of the study revealed that heart rejection in drug treated animals was significantly lower than in corresponding controls but not different among the various drug treated groups. In the kidney, there were no differences in glomerular tuft area or tuft volume density amongst drug-treated or control animals. In contrast, tubule atrophy and interstitial fibrosis were markedly greater in CsA-treated vs RAPA-treated animals (X2 5.00, p < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1997

Permanent pacing for asystole of the donor heart after heterotopic heart transplantation.

A 41-year-old woman presented with shortness of breath and decreased exercise tolerance 1 year after heterotopic heart transplantation. She was found to have an ejection fraction of less than 20% for the native heart and severely depressed left ventricular systolic function of the donor heart. A left ventriculogram of the donor heart showed no systolic contractility. A permanent pacemaker was implanted into the right ventricle of the donor heart. One year after pacemaker insertion, systolic function of the donor heart had returned to normal.

Adult↗

PubMed1997

Gingival overgrowth in pediatric heart and heart-lung transplant recipients.

BACKGROUND: Gingival overgrowth is a recognized side effect of cyclosporine therapy with cosmetic and functional sequelae. This study examines the incidence and severity of gingival overgrowth in pediatric heart and heart-lung transplant recipients. METHODS: Thirty-one pediatric heart and heart-lung transplant recipients underwent a comprehensive dental evaluation. The severity of gingival overgrowth was scored by use of dental plaster casts. Parameters of dental hygiene in each patient included both a plaque index and a gingival inflammation index. The mean cyclosporine level and daily dose (mg/kg/day) at 3 and 12 months after transplantation and at latest follow-up were determined. RESULTS: The mean (+/- SD) patient age at transplantation was 10.5 (+/- 5.5) years, and the mean duration of posttransplantation follow-up was 3.2 (+/- 2.1) years. In all 30/31 (97%) of the cohort had some degree of overgrowth, with children aged less than 10 years at time of transplantation the most severely affected. By univariate analysis gingival overgrowth was inversely related to age at time of transplantation (r = -0.67, p < 0.001). With multiple regression analysis, only age at transplantation was significantly related to gingival overgrowth. CONCLUSIONS: Gingival overgrowth occurs in most pediatric heart and heart-lung transplant recipients treated with cyclosporine and is most severe in the younger patients. Attention to oral hygiene may improve gingival health parameters; however, the daily weight-adjusted dose of cyclosporine is not related to the severity of overgrowth.

Age Factors↗

PubMed1997

[Pregnancy after heart and heart-lung transplantation. Apropos of 10 cases and review of the literature].

INTRODUCTION: A survey of all French Centres performing heart and heart lung transplant provided an exhaustive registry of pregnancy after transplantation. MATERIAL AND METHODS: A questionnaire was sent to 36 Centres. Anonymous reports of transplantation and subsequent pregnancies which occurred between 1984 and 1994 were analyzed. RESULTS: Among 1290 heart and 120 heart lung transplantations performed during the study period 10 pregnancies were reported in 9 patients (6 after heart transplantation and 3 heart-lung transplantation) who gave birth to 11 neonates. The interval between the transplantation and the pregnancy is 23.1 months (range: 10-39). High blood pressure complicated nine pregnancies and severe preeclampsia occurred in two cases. Immunosuppressive therapy was i) Cyclosporine alone (n = 1), ii) i with corticosteroid therapy (n = 7), iii) ii with azathioprine (n = 2). One patient developed Kaposi sarcoma of the cervix. Delivery at 35 (27-39) weeks' gestation was by caesarean section in 50% of the cases. Mean birthweight was 1990 gm (range: 700-2880) and 50% of the neonates were below the tenth centile. One child developed cardiomyopathy as diagnosed in her mother and another one was diagnosed with congenital hepatitis B by absence of prophylaxis at birth. All the patients are alive at this time.

Adrenal Cortex Hormones↗

PubMed2005

Pediatric bridge to heart transplantation: application of the Berlin Heart, Medos and Thoratec ventricular assist devices.

BACKGROUND: Bridge to transplantation (BTT) is an accepted option when a donor heart is not available. Extensive clinical study has been done with BTT in the adult population, but comparatively fewer data are available in the pediatric population with regard to pulsatile devices. METHODS: Ten pediatric patients are presented, all of whom underwent BTT or recovery with pneumatic paracorporeal systems. The Berlin Heart bi-ventricular assist device (BVAD) was utilized in 1 patient, the Medos VAD in 4 patients (1 left ventricular assist device [LVAD], 3 BVADs) and the Thoratec VAD in 5 patients (3 BVADs, 2 LVADs). The pediatric population consisted of 3 females and 7 males. Mean age of the population was 7.4 years, weight 25 kg and body surface area (BSA) 0.88 m(2). Etiology for heart failure consisted of 4 viral, 3 congenital and 3 idiopathic cardiomyopathies. Before implant, all patients had evidence of progressive cardiac failure despite inotropic support, and 2 patients had been on extracorporeal membrane oxygenation (ECMO). Mean duration on the device was 34.3 days (8 to 107 days). RESULTS: Two patients suffered stroke and recovered without sequelae. Two patients died of ischemic stroke and 1 of sepsis. Seven patients survived (6 transplanted and 1 weaned) for a survival rate of 70% compared with survival for ECMO as BTT, which was 40% to 50%. All survivors had complications related to bleeding, thromboembolic events and infections. CONCLUSIONS: The Thoratec VAD can be placed in small patients with large hearts that can accommodate the available cannulas. The Berlin Heart and the Medos VAD have a selection of ventricles with small stroke volumes. All 3 systems can be used successfully in the pediatric population as BTT with better survival than with ECMO.

Adolescent↗

PubMed1988

Response of heart rate to atropine and left ventricular function in Chagas' heart disease.

Chagasic patients may have a normal or abnormal response of heart rate to atropine. To determine if this response to atropine is related to the degree of left ventricular dysfunction, we studied 33 patients with a positive complement fixation test for Chagas' disease. Eleven subjects, with atypical chest pain and negative complement fixation test, were used as controls (sero-negative). Left ventricular wall motion and the left ventricular volumes were determined by ventricular cineangiography. Coronary arteriography was also performed. The sero-negative subjects had normal left ventricular wall motion and the left ventricular diastolic volume was 88 +/- 24 ml/m2. The response of heart rate to atropine was 50 +/- 8 (mean +/- SD) (range 40-65 beats/min). On the basis of the response to atropine, the chagasic patients were divided into groups with a normal response (greater than 40 beats/min) and those with an abnormal response (less than 40 beats/min). Sixty five per cent of those with a normal response had left ventricular apical aneurysms. The left ventricular end-diastolic volume was not significantly different from the sero-negative subjects (96 +/- 26 ml/m2). Six patients (30%) had a left ventricular diastolic volume between 110 and 140 ml/m2. Sixty two per cent of those chagasic subjects with an abnormal response had diffuse left ventricular hypokinesis, and the left ventricular end-diastolic volume was 192 +/- 49 ml/m2 (P less than 0.01). The response of heart rate and the left ventricular diastolic volume were inversely correlated in the chagasic patients (r = -0.88, P less than 0.01). Our results indicate that myocardial damage and the degree of left ventricular dilatation are more severe in chagasic patients with an abnormal response of their heart rate to atropine. Furthermore, the inverse correlation between these two variables is highly indicative of a relationship between the response of heart rate to atropine and the degree of left ventricular dysfunction.

Adult↗