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The Impact of a Prior Norwood Procedure on cardiac transplantation in Failed Fontan Physiology

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Congenital Heart Disease 2024年第3期19卷 257-266页

作者： Ryan G.McQueen Nikki M.Singh Ronald K.Woods Medical College of Wisconsin Herma Heart Institute at Children’s WisconsinMilwaukeeUSA Division of Pediatric Cardiology Medical College of WisconsinHerma Heart Institute at Children’s WisconsinMilwaukeeUSA Division of Pediatric Cardiothoracic Surgery Medical College of WisconsinHerma Heart Institute at Children’s WisconsinMilwaukeeUSA

Objective:The objective of this study was to compare cardiac transplant operative and postoperative courses of patients with failed Fontan physiology who were initially palliated with a Norwood(FFN)to those without a prior Norwood(FF).Methods:A single-institution retrospective review of all patients with Fontan failure who under-went cardiac transplantation from 2003–2021 was completed-22 underwent prior Norwood(FFN)and 11 did not(FF).Descriptive and inferential statistics were calculated for operative course and patient ***:The operative course of the FFN cohort appeared to be more complex(not statistically significant,but clinically relevant)-this group exclusively experienced sternal re-entry events(3 of 22 patients)and concomitant neo-aor-tic reconstruction(6 patients),had a longer duration of surgery(median of 682 min vs.575.5 min),more time on circulatory arrest(median of 25.5 min vs.12.5 min),and more frequent use of open sternal management[50%of patients(11/22)vs.27.3%of patients(3/11)].Postoperatively,these patients underwent more mediastinal explora-tions[other than sternal closure;40.9%of patients(9/22)vs.18.2%of patients(2/11)],spent more time on mechanical ventilation(median of 5 days vs.2 days),had a longer length of stay(median of 30 days vs.19 days),and required more catheter-based re-interventions[22.7%of patients(5/22)vs.9.1%of patients(1/11)].Conclu-sion:Although underpowered,our results suggest that the operative course of FFN patients is more challenging,based mostly on neo-aortic arch *** turn,this likely leads to a more complex postoperative *** are currently collaborating with other institutions to increase the cohort size and power of the study.

关键词： Fontan Fontan failure Norwood cardiac transplantation

Integrated management of cardiac failure:the cardiac failure clinic

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Frontiers of Medicine 2011年第1期5卷 20-25页

作者： Daniel LOISANCE La Pitie Hospital Paris 75013France

The prevalence of the risk factors and the risk of cardiac failure are both increasing in *** might be the consequence of the changes of the life conditions(emigration to the urban areas,changes in the diet and life style,lack of physical exercise,etc.).The wide range of clinical presentations of cardiac failure(acute or chronic)and of therapeutic approaches(medical or surgical)makes necessary the integration within the same structure of the various experts involved in the diagnosis and the treatment of cardiac *** and human resources required to offer all the options represent a multifaceted commitment which should be focused optimally in dedicated *** these centers,collaboration should replace competition between the medical and the surgical cardiac *** of team work should permit to optimize the cost efficacy of the *** of all,such a structure will facilitate the translation of innovative therapies between the research centers and clinical facilities.

关键词： cardiac failure cardiac transplantation mechanical circulatory support

Development of pulmonary hypertension remains a major hurdle to corrective surgery in Down syndrome

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World Journal of Cardiology 2024年第1期16卷 1-4页

作者： Akash Batta Juniali Hatwal Department of Cardiology Dayanand Medical College and HospitalLudhiana 141001PunjabIndia Department of Internal Medicine Post Graduate Institute of Medical Education&ResearchChandigarh 160012India

Down syndrome is the most common chromosomal abnormality encountered in clinical practice with 50%of them having associated congenital heart disease(CHD).Shunt lesions account for around 75%of all CHDs in Down *** syndrome patients,especially with large shunts are particularly predisposed to early development of severe pulmonary hypertension(PH)compared with shunt lesions in general *** necessitates timely surgical correction which remains the only viable option to prevent long term morbidity and ***,despite clear recommendations,there is wide gap between actual practice and fear of underlying PH which often leads to surgical refusals in Down syndrome even when the shunt is *** peculiarity is that Down syndrome patients can develop PH even after successful correction of *** is not uncommon to come across Down syndrome patients with uncorrected shunts in adulthood with irreversible PH at which stage intracardiac repair is contraindicated and the only option available is a combined heartlung ***,despite the guidelines laid by authorities,the rates of cardiac transplant in adult Down syndrome remain dismal largely attributable to the high prevalence of intellectual disability in *** index case presents a real-world scenario highlighting the impact of severe PH on treatment strategies and discrimination driven by the fear of worse outcomes in these patients.

关键词： Down syndrome Congenital heart disease Pulmonary hypertension cardiac transplantation Pulmonary vascular resistance Surgical correction

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Chinese Medical Journal 2012年第7期125卷 1352-1354页

作者： LIU Tong GAO Yun GAO Yu-long CHENG Yu-tong WANG Su LI Zhi-zhong ZHANG Hai-bo MENG Xu MA Chang-sheng DONG Jian-zeng Departement of Cardiology Beijing Anzhen HospitalCapital Medical UniversityBeijing 100029China

Left ventricular hypertrophy associated with the use of tacrolimus is a rare complication of solid organ transplantation in adult recipients. We present a cardiac transplant recipient who developed severe concentric left ventricular hypertrophy with congestive heart failure related to myocardial hypertrophy on tacrolimus. Hypertrophy improved when the drug was discontinued and replaced with sirolimus.

关键词： cardiac transplantation left ventricular hypertrophy tacrolimus sirolimus

Activation of Aryl Hydrocarbon Receptor Prolongs Survival of Fully Mismatched cardiac Allograft

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2013年第2期33卷 199-204页

作者：蔡兰军余道武高义杨超周鸿敏陈忠华 The Institute of Organ transplantation Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Key Laboratory of Ministry of Health Key Laboratory of Ministry of Education Department of Hepatobiliary Surgery Yongchuan Affiliated Hospital Chongqing Medical University Department of cardiac and Thoracic Surgery Tongji Hospital Tongji Medical College Huazhong University of Science and Technology

Recent data suggest that activation of aryl hydrocarbon receptor （AhR） by its high-affinity ligand 2,3,7,8-tetrachlorodihenzo-p-dioxin （TCDD） results in expansion of regulatory T （Treg） cells and suppresses the development of autoimmune and allergic diseases in several models. Treg cells have been increasingly documented to suppress allograft rejection and even to establish stable long-term graft acceptance. However, the involvement of TCDD in the regulation of solid organ transplantation rejec- tion is largely unknown. Here, we examined whether activation of AhR with TCDD altered cardiac al- lograft rejection in an allogeneic heart transplant model. Recipient C57BL/6 （H-2b） mice were adminis- trated with a single intraperitoneal injection of TCDD, and the murine cardiac transplant models from BALB/c （H-2d） to C57BL/6 （H-2b） were built 24 h later. The complete cessation of cardiac contractility was defined as the observation endpoint. The effect of TCDD on T-cell proliferation was assessed by mixed lymphocyte reaction （MLR）. Histological and immunohistochemical analyses were performed to estimate the severity of rejection. The phenotype and cytokine profile of lymphocytes were analyzed by flow cytometry and enzyme-linked immunosorbent assay （ELISA）. Activation of AhR remarkably pro- longed the survival of cardiac allografts to more than 20 days. In vitro, TCDD ugregulated the fre- quency of CD4＋CD25＋Foxp3＋ Treg cells and suppressed the proliferation of T lymphocytes. In vivo, the prolonged survival time was associated with increased number of Treg cells in allografls and spleens Furthermore, the secretion of interferon-3, （IFN-3,） and interleukin-17 （IL-17） was reduced to less than 50% of that of the PBS treatment control group by TCDD treatment, whereas IL-10 was elevated to 10-fold of that of the PBS treatment control group. Collectively, our data indicate that activation of AhR with a single dose of TCDD significantly prolonged the survival of fully allogeneic ca

关键词： aryl hydrocarbon receptor 2,3,7,8-tetrachlorodibenzo-p-dioxin cardiac transplantation regulatory T cells acute rejection

Orthotopic Heart Auto-transplantation in a Swine Model

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World Journal of Cardiovascular Surgery 2022年第9期12卷 200-206页

作者： Michael P. Rogers Gregory Fishberger Nick Martini Margaret Baldwin Lei Wang Wei Chen Ruisheng Liu Lucian Lozonschi Division of Cardiothoracic Surgery Department of Surgery University of South Florida Morsani College of Medicine Tampa FL USA Department of Comparative Medicine University of South Florida Tampa FL USA Department of Molecular Pharmacology and Physiology University of South Florida Morsani College of Medicine Tampa FL USA Department of Physics College of Arts and Sciences University of South Florida Tampa FL USA

Background and Aim: The porcine heart bears the best resemblance to the human heart and remains the preferred preclinical model for anatomical, physiological, and medical device studies. In an effort to study phenomena related strictly to ischemia reperfusion and donor preservation protocols, it is essential to avoid the immune responses related to allotransplantation. Orthotopic auto-transplantation is a unique strategy to the field of cardiac transplantation for ex vivo experimentation. Nevertheless, auto-transplantation carries its own technical challenges related to insufficient length of the great vessels that are to be transected and re-anastomosed. Methods: A novel method for orthotopic cardiac auto-transplantation in the porcine model was developed and was described herein. Porcine models were used for ex vivo experimentation of a novel device to study ischemia reperfusion injury. Results: A total of five porcine models were used for ex vivo experimentation of a novel device to mitigate ischemia reperfusion injury and determine effects of donor preservation. Modifications to routine cardiac transplantation protocols to allow for successful auto-transplantation are described. Conclusion: Orthotopic cardiac auto-transplantation in the porcine model is a plausible and technically feasible method for reliable study of ischemia reperfusion injury and donor preservation protocols. Here, we describe methods for both direct orthotopic porcine cardiac auto-transplantations as well as a simplified protocol that can be substituted for full surgical auto-transplantation for the studies of preservation of donor hearts.

关键词： Porcine cardiac Surgery cardiac transplantation

Mechanical Thrombectomy in Post-Transplant Heart

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World Journal of Cardiovascular Diseases 2016年第10期6卷 338-341页

作者： Puneeth Shridhar Ramzi Khalil Triston Smith Gustav Eles David Lasorda Young Jae Chun Department of Bioengineering University of Pittsburgh Pittsburgh USA Department of Cardiology Allegheny General Hospital Pittsburgh USA Department of Cardiology Wheeling Hospital Wheeling USA Department of Industrial Engineering University of Pittsburgh Pittsburgh USA McGowan Institute for Regenerative Medicine Pittsburgh USA

Coronary allograft vasculopathy (CAV) is an accelerated form of coronary artery disease that is responsible for significant mortality after cardiac transplantation. We report a case of CAV with significant thrombus burden which was managed with mechanical thrombectomy. Both aspiration and mechanical thrombectomy can be safely done in cardiac transplant recipients and may be considered in order to minimize exposure to coronary artery bypass procedure. This is especially valuable in emergency circumstances.

关键词： cardiac transplantation Heart transplantation Coronary Allograft Vasculopathy