Document Detail


Left ventricular pressure measurement by telemetry is an effective means to evaluate transplanted heart function in experimental heterotopic cardiac xenotransplantation.
MedLine Citation:
PMID:  20692431     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Evaluation of the function of heterotopic cardiac transplants has traditionally been accomplished by either manual palpation or serial biopsies. Both methods have drawbacks. Palpation can be difficult to differentiate a pulse from the graft versus a transmitted pulse from the native aorta. Serial biopsies, though accurate, require multiple laparotomies, leading to increased morbidity and possibly mortality rates. In this study we used an advanced telemetry system, consisting of an intra-abdominal implant, that was capable of continuously monitoring simultaneously several parameters of the transplanted heart and the status of the recipient. In a large animal model of heterotopic cardiac xenotransplantation (pig donor to baboon recipient), we implanted the device in 12 animals: 8 with and 4 without immunosuppression. We monitored and continuously recorded the left ventricular pressure (both peak-systolic and end-diastolic [LVEDP]), heart rate, and the electrocardiogram pattern of the transplanted heart as well as the temperature of the recipient. The left ventricular pressure proved to be the most valuable parameter to assess graft heart function. In the 4 nonimmunosuppressed cases, grafts were rejected acutely. In these cases, the end-diastolic pressure increased sharply and the heart stopped contracting when the difference between the systolic and the diastolic pressure decreased to <10 mm Hg. The earliest reproducible sign of rejection was an increased LVEDP. Among long-term survivors, the increase in diastolic pressure was gradual, indicating progressive thickening of the myocardium and decreased compliance of the ventricle. Six of 8 immunosuppressed animals died of other complications before rejecting the transplanted heart. The telemetry was also helpful to indicate early onset of fever in the recipients, thus allowing us to intervene early and prevent potentially lethal septic complications. Continuous monitoring of several parameters via telemetry allowed detection of changes associated with rejection as well as other complications at an early stage, allowing prompt intervention, treatment, and possibly reversal of rejection.
Authors:
K A Horvath; P C Corcoran; A K Singh; R F Hoyt; C Carrier; M L Thomas; M M Mohiuddin
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Transplantation proceedings     Volume:  42     ISSN:  1873-2623     ISO Abbreviation:  Transplant. Proc.     Publication Date:    2010 Jul-Aug
Date Detail:
Created Date:  2010-08-09     Completed Date:  2011-01-14     Revised Date:  2012-03-08    
Medline Journal Info:
Nlm Unique ID:  0243532     Medline TA:  Transplant Proc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2152-5     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
Affiliation:
Cardiothoracic Surgery Research Program, National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892, USA.
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MeSH Terms
Descriptor/Qualifier:
Anastomosis, Surgical / methods
Animals
Graft Rejection / immunology,  pathology
Graft Survival / immunology
Heart Transplantation / adverse effects*,  immunology
Immunosuppressive Agents / therapeutic use
Papio
Survivors
Swine
Telemetry / methods*
Tissue Donors
Transplantation, Heterologous / adverse effects*
Grant Support
ID/Acronym/Agency:
Z99 HL999999/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Immunosuppressive Agents
Comments/Corrections

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