Article

lock Open Access lock Peer-Reviewed

0

Views

ORIGINAL ARTICLE

Human cardiac transplant: initial experience

Noedir A. G Stolf; Edimar Bocchi; Pedro C. P Lemos; Fabio Biscegli Jatene; Pablo M. A Pomerantzeff; Lourdes Higushi; Jorge Kalil; Alfredo I Fiorelli; José Otávio C Auler Júnior; Giovanni Bellotti; Lélio A Silva; Fúlvio Pileggi; Adib D Jatene

DOI: 10.1590/S0102-76381986000200008

ABSTRACT

At the Instituto do Coração, University of São Paulo Medical School, 11 patients were submitted to heart transplantation from march 1985 up to february 1986. All were male, with ages of 39-59 years, 6 with coronary heart disease, 4 with dilated cardiomyopathy and 1 with Chagas cardiomyopathy. The patients were studied hemodynamically with a Swan-Ganz catheter pre-operatively, at the arrival in the intensive care unit, in the first postoperative day and 30 or more days after the transplant. The data showed that there was a progressive increase of cardiac index and decreases of pulmonary artery pressure, capilary pulmonary wedge pressure, pulmonary vascular resistance and systemic vascular resistance. Three of the 11 patients had immediate renal dysfunction that returned to normal by the 15th day. Late postoperatively 2 patients had increase of creatinine levels. Only 3 patients had no rejection episodes; among the others these episodes were represented by hystological alterations with no clinical manifestations. Infections complications occurred in 9 patients and were easily clinically treated. Late postoperatively, hypertension was present in 8 patients; in 2 of them it was moderate. There was no death in these 11 patients; all are symptom free and the first 6 are working.

RESUMO

No Instituto do Coração, de março de 1985 a fevereiro de 1986,11 pacientes foram submetidos a transplante cardíaco ortotópico. Eram todos do sexo masculino, com idade variando de 39 a 54 anos; 6 com cardiopatia isquémica, 4 com cardiomiopatia dilatada e um com cardiomiopatia chagásica. Foi realizado estudo hemodinâmico através de catéter de Swan-Ganz, no pré-operatório, no pós-operatório, após estabilização na unidade de recuperação, e trinta ou mais dias após o transplante. Os dados mostram melhora progressiva em relação ao índice cardíaco, pressão em artéria pulmonar, pressão de capilar pulmonar, resistência vascular pulmonar e resistência vascular sistêmica. Três dos 11 pacientes apresentaram disfunção renal transitória no pós-operatório imediato e que regrediram até o 15º dia, enquanto que 2 pacientes apresentaram aumento moderado da creatinina plasmática. Apenas 3 pacientes não apresentaram qualquer episódio de rejeição; nos demais, esses episódios foram um diagnóstico histológico sem repercussões clínicas. Complicações infecciosas ocorreram em 9 pacientes e foram de fácil controle clínico. No pós-operatório tardio, a hipertensão esteve presente em 8 pacientes, sendo mais acentuada em 2 deles. Não houve óbitos, nesta série de pacientes; todos estão assintomáticos e os 6 primeiros estão trabalhando.
Full text available only in PDF format.

REFERENCES

1. BARNARD, C. N. - A human cardiac transplant: an interim report of a successful operation performed at Groote Schuur-Hospital. Cape Towun. S. Afr. Med. J., 41 (48): 1271-1274, 1967. [MedLine]

2. BAUMGARTNER, W. A.; REITZ, B. A.; BIEBER, C. P.; OYER, P. E.; SHUMWAY, N. E.; STINSON, E. B. - Current expectation in cardiac transplantation. J. Thorac. Cardiovasc. Surg., 75 (4): 525-530, 1978. [MedLine]

3. BILLINGHAM, M. E. - Diagnosis of cardiac rejection by endomyocardial biopsy. Heart Transplant, 1 (1): 25-30, 1981.

4. JAMIESON, S. W. - Recent developments in heart and heart-lung transplantation. Transplant. Proc., 17 (1): 199-203, 1985.

5. JAMIESON, S. W.; OYER, P. E.; REITZ, B. A.; BAUMGARTNER, W. A.; BIEBER, C. P.; STINSON, E. B.; SHUMWAY, N. E. - Cardiac transplantation at Stanford. Heart Transplant., 1(1 ):86-91, 1982.

6. LOWER, R. R.; DONG, E.; SHUMWAY, N. E. - Long-term survival of cardiac homografts. Surgery, 58 (1): 110-119, 1965.

7. OYER, P. E.; STINSON, E. B.; JAMIESON, S. W.; HUNT, S.; REITZ, B. A.; BIEBER, C. P.; SCHOEDER, J.; BILLINGHAM, M.; SHUMWAY, N. E. - One year experience with cyclosporine A in clinical heart transplantation. Heart Transplant, 1 (4):285-290, 1982.

8. STINSON, E. B. - Overal review of the Stanford program and results In: Cardiac e transplantation at Stanford. Stanford University, Stanford, USA, 7-9 out. 1985.

9. YACOUB, M.; ALIVIZATOS, P.; KHAGHANI, A ; MITCHELL, A. - The use of cyclosporine, azathioprine, and antithymocyte globulin with or without low-dose steroids for immunosuppression of cardiac transplant patients. Transplant. Proc., 17 (1): 221-222, 1985.

CCBY All scientific articles published at bjcvs.org are licensed under a Creative Commons license

Indexes

All rights reserved 2017 / © 2020 Brazilian Society of Cardiovascular Surgery DEVELOPMENT BY