The Journal of heart transplantation
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Case Reports
Implantation of an external biventricular assist device: role of transesophageal two-dimensional echocardiography.
A patient with end-stage dilated cardiomyopathy underwent implantation of a pulsatile external biventricular assist device as a bridge to heart transplantation. The device insertion was guided by transesophageal two-dimensional echocardiography that proved extremely helpful in allowing expeditious and precise positioning of both right and left atrial withdrawal cannulas.
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Case Reports
Does central nervous system toxicity occur in transplant patients with hypocholesterolemia receiving cyclosporine?
A syndrome of severe central nervous system toxicity (confusion, cortical blindness, quadriplegia, seizures, and coma) associated with cyclosporine therapy and a low serum cholesterol level in patients with liver transplants has been described. We present a case history of a patient who demonstrated several similar features after heart-lung transplantation. Possible cyclosporine neurotoxicity should be considered in any patients with hypocholesterolemia receiving this drug.
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Orthotopic heart transplantation was performed in a 21-year-old medical student 11 years after left pneumonectomy for a rhabdomyosarcoma. The cardiomyopathy was the result of the administration of doxorubicin (Adriamycin). ⋯ The early postoperative course was mainly uneventful. The patient is doing well 9 months after operation, without any episode of rejection or infection.
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Fifty-two consecutive patients who underwent orthotopic heart transplantation at our institution were evaluated by two-dimensional (2D) echocardiography at frequent intervals for 12 weeks after transplantation and at three monthly intervals for 1 year. Thirty-eight of 52 patients had adequate 2D echocardiograms and comprised the retrospective study group. Pericardial effusion was documented in 15 of 38 patients (40%). ⋯ Follow-up 2D echocardiograms obtained 301 +/- 106 days after transplantation were available in 25 patients. Fifteen patients (60%) had no pericardial effusion present on either the initial or follow-up 2D echocardiogram. The majority of cases of the pericardial effusion present on initial or follow-up echocardiograms were resolving on the follow-up study.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
Comparison of cardiac rejection in heart and heart-lung transplantation.
Cardiac biopsy remains the principal tool for diagnosis of rejection in heart and heart-lung transplantation. In rare instances pulmonary rejection may occur without cardiac rejection, but the overall incidence of cardiac rejection may be less with heart-lung transplantation than with heart transplantation. During the 6 months from March to September 1986, 40 heart transplantations and nine heart-lung transplantations were performed. ⋯ Cyclosporine levels were determined by radioimmunoassay, and cardiac rejection was diagnosed by serial endomyocardial biopsy. Early cardiac rejection is notably less common after heart-lung transplantation than after heart transplantation. Although the prophylactic antithymocyte globulin given in heart-lung transplantation may be important in this regard, rejection is probably inherently less common after heart-lung transplantation.