| Reversal of severe late left ventricular failure after pediatric heart transplantation and possible role of plasmapheresis. | |
| | |
MedLine Citation:
|
PMID: 12000049 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
Late acute cardiac graft failure carries a high mortality in adults. Vascular mediators and factors other than classic T-cell-mediated rejection may play a role in this process, and aggressive multimodality therapy may improve survival. We report experience with plasmapheresis in treating late severe acute left ventricular dysfunction in a group of pediatric heart transplant recipients. We retrospectively reviewed clinical records, echocardiograms, hemodynamics, coronary angiograms, biopsy specimens, and treatment regimens for 5 patients with 7 episodes of late-onset severe graft failure who recovered. Plasmapheresis was applied in all cases, in addition to methylprednisolone, cyclophosphamide, lympholytic agents, and aggressive supportive care including mechanical ventilation and hemofiltration. All patients presented with acute severe left ventricular dysfunction 1.4 to 7.9 years (mean 3.6) after orthotopic heart transplantation. Mean shortening fraction at presentation was 13 to 23% (mean 16), initial endomyocardial biopsy specimens were grade 0 to 3B, and immunofluorescence studies were negative. Treatment included plasmapheresis, cyclophosphamide, mechanical ventilation, hemofiltration, and inotropes. Clinical recovery was slow, with 4 to 8 weeks until left ventricular function normalized, and 2.2 to 9.4 (mean 4.6) weeks to hospital discharge. At follow-up (50 to 38 months, mean 24), all are alive. Two patients are well, whereas coronary vasculopathy developed in 3. Thus, survival may improve in patients with late graft failure with low biopsy score and plasmapheresis combined with multimodality therapy. |
| | |
Authors:
|
E Pahl; S E Crawford; R A Cohn; S Rodgers; D Wax; C L Backer; C Mavroudis; S S Gidding |
Related Documents
:
|
20559889 - Acute cardiac disease in a young patient with campylobacter jejuni infection: a case re... 11318899 - Myocardial fibrosis assessment by semiquantitative, point-counting and computer-based m... 3263629 - Qs pattern in the right precordial leads of a child with extensive myocardial fibrosis ... 19055189 - Cardiac pathological conditions in young soldiers: case series. 438049 - Myocarditis of probable viral origin in pups of weaning age. 3883769 - Sarcoidosis mimicking cor triatriatum. echolucency of adenopathy due to sarcoidosis. 6338889 - Effect of very early intervention with metoprolol on myocardial infarct size. 16996959 - Development of a novel temporary epicardial pacing wire with biodegradable film. 907399 - Pharmacological preservation of the ischemic heart. |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: The American journal of cardiology Volume: 85 ISSN: 0002-9149 ISO Abbreviation: Am. J. Cardiol. Publication Date: 2000 Mar |
Date Detail:
|
Created Date: 2002-05-09 Completed Date: 2002-05-23 Revised Date: 2004-11-17 |
Medline Journal Info:
|
Nlm Unique ID: 0207277 Medline TA: Am J Cardiol Country: United States |
Other Details:
|
Languages: eng Pagination: 735-9 Citation Subset: AIM; IM |
Affiliation:
|
Department of Pediatrics, Pathology, and Surgery, Chidren's Memorial Hospital, Northwestern University Medica School, Chicago, Illinois 60614, USA. epahl@nuw.edu |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adolescent Adult Child Combined Modality Therapy Cyclophosphamide / therapeutic use Follow-Up Studies Graft Rejection / prevention & control Heart Transplantation Hemofiltration Humans Immunosuppressive Agents / therapeutic use Plasmapheresis* Postoperative Complications / therapy* Respiration, Artificial Retrospective Studies Time Factors Ventricular Dysfunction, Left / epidemiology, therapy* |
| Chemical | |
Reg. No./Substance:
|
0/Immunosuppressive Agents; 50-18-0/Cyclophosphamide |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Extracardiac anomalies in the heterotaxy syndromes with focus on anomalies of midline-associated str...
Next Document: Clinical impact of second harmonic imaging and left heart contrast in echocardiographic stress testi...