Document Detail

Reversal of severe late left ventricular failure after pediatric heart transplantation and possible role of plasmapheresis.
MedLine Citation:
PMID:  12000049     Owner:  NLM     Status:  MEDLINE    
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.
E Pahl; S E Crawford; R A Cohn; S Rodgers; D Wax; C L Backer; C Mavroudis; S S Gidding
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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    
Department of Pediatrics, Pathology, and Surgery, Chidren's Memorial Hospital, Northwestern University Medica School, Chicago, Illinois 60614, USA.
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MeSH Terms
Combined Modality Therapy
Cyclophosphamide / therapeutic use
Follow-Up Studies
Graft Rejection / prevention & control
Heart Transplantation
Immunosuppressive Agents / therapeutic use
Postoperative Complications / therapy*
Respiration, Artificial
Retrospective Studies
Time Factors
Ventricular Dysfunction, Left / epidemiology,  therapy*
Reg. No./Substance:
0/Immunosuppressive Agents; 50-18-0/Cyclophosphamide

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