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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cyclosporine therapy after heart and lung transplantation implies a number of specific aspects such as: kidney deficiency associated to heart failure, which delays its use as for cardiac transplantation; intestinal absorption disturbances that could be linked to the cystic fibrosis disease for lung transplantation. For both types of transplantation, local efficiency could indicate an interesting, but still unexplored therapeutic effect. Finally, it seems that the immunosuppressive effect could be linked to important pharmacological effect on calcium and could explain the specific aspects of rejection of patients under cyclosporine.
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PMID:[Cyclosporine. Obscure sides of cardiac and pulmonary transplantations]. 149 96

During the period from 1984-1991 in the Institute of Clinical and Experimental Medicine 72 orthotopic transplantations of the heart were performed in 71 patients with irreversible cardiac failure. Indication for transplantation in 39 patients was IHD, in 28 cardiomyopathy, in 3 RHD and in one instance a tumour. The mean age of the patients was 41 years, the youngest patient was 17 and the oldest 62 years old. Immunosuppression involved a combination of three preparations Azathioprine, corticoids and Cyclosporine A. Nineteen patients died within one month after operation. The most frequent cause of death was cardiac failure. As to postoperative complications, renal failure was most frequent. Fifty patients were followed-up on a long-term basis. The longest survival period was 8 years and 2 months. The most frequent cause of death in the long-term follow-up was sudden death caused in the majority most probably by rapid development of coronary disease.
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PMID:[Personal experience with heart transplantation]. 152 82

The article deals with experience in the first transplantation of a heart-lung complex in the USSR. The recipient was a 34-year-old male with dilation cardiomyopathy. It was decided to perform the transplantation because the terminal stage of cardiac failure and secondary pulmonary hypertension developed (cardiac index 1.3 l/m, pressure in pulmonary artery 80/50 mm Hg, resistance of pulmonary vessels 10.4 units after Wood). The heart and lung were transplanted from a 19-year-old male who died from a craniocerebral injury. Cyclosporine, metipred , imuran, dopamine in small doses, cardiotonics, and antibiotics were given in the postoperative period; the patient was kept on artificial respiration for 48 hours. For up to 10 days the patient's condition was relatively stable and his consciousness was clear. Bilateral pneumonia developed, however, from which he died on the 12th postoperative day. The article discusses organizational problems and some questions of immunosuppressive therapy, immunological monitoring, and the management of patients after transplantation of a heart-lung complex.
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PMID:[Transplantation of the heart-lung complex (the first clinical experience)]. 177 Jul 47

Heart transplantation (HTx) has now become an accepted treatment modality for end-stage heart disease. The limited supply of suitable donor organs imposes constraints upon the decision of who should be selected for transplantation. Usually patients are candidates for HTx, who remain NYHA functional class III or IV despite maximal medical therapy. Further criteria are low left ventricular ejection fraction (less than 20%) with heart rhythm disturbances class IIIA-V (LOWN), which are associated with poor prognosis. Additionally, the suffering of the patient and also the course of heart failure are essential for judging the urgency of HTx. Contraindications are absolute in patients with untreated infections, fixed pulmonary vascular resistance (PVR) above 8 WOOD-degrees, severe irreversible kidney and liver disease, active ventricular or duodenal ulcers and acute, psychiatric illness. HTx is relatively contraindicated in patients with diabetes mellitus, age over 60 years, PVR above 6 WOOD-degrees and an unstable psychosocial situation. To prevent rejection of the transplant heart, live-long immunosuppressive therapy is needed. Most immunosuppressive regimes consist of Cyclosporine A and Azathioprine (double drug therapy) or in combination (tripple drug therapy) with Prednisolone. For monitoring of this therapy, control of hole blood cyclosporine A level and white blood count is needed. Rejection episodes can be suspected if there is a greater than 20 mmHg decrease of systolic blood pressure, elevated body temperature, malaise, tachycardia or heart rhythm disturbance. The diagnosis of cardiac rejection can be established by endomyocardial biopsy. Measurement of the voltage of either the surface or intramyocardial ECG, echocardiography with special consideration to early left ventricular filling time as well as immunological methods are additionally used tools. Graft sclerosis as the main risk factor of the late transplant period remains an unsolved problem.
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PMID:[Therapy of terminal heart failure using heart transplantation]. 192 Dec 33

Fifty to 100 children receive transplanted kidneys, hearts, livers, or bone marrow in Florida each year and many more bone allografts or other tissues (skin, cornea). Children are in the minority of the total solid organ transplantation but those with successful transplants are strong proponents of the procedure. Many (liver or heart failure) would have died without transplantation; others (kidney failure) would have lived but been tied to dialysis for life. The success rate varies with the organ or tissue transplanted. Some children return to a completely normal life without the need for immunosuppressive medications. Others require them continually. Cyclosporine, azathioprine and prednisone are the most frequently used. Rejection continues to be the leading cause of graft loss. Major impediments to solid organ transplantation are the paucity of acceptable organs and the high cost associated with maintenance of transplant patients.
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PMID:Pediatric tissue and organ transplantation in Florida. 177 61

Since our initial orthotopic heart transplant (OHT) in 1968, the first in Europe, 1130 patients with ages ranging from 1 month to 66 years have been referred to us. The cause of irreversible myocardial damage was idiopathic cardiomyopathy in 74%, ischemic heart disease in 19% and left ventricular failure after valvular replacement in 7%. A total of 540 transplantations, 463 orthotopic, 40 heterotopic and 37 heart-lungs were carried out. Features of the early post-operative course include temporary (first week) cardiac instability treated by isoproterenol. Later complications included rejection (95%) and side-effects of immunosuppressive therapy; infection (83%), osteoporosis, malignancy, graft atherosclerosis (2%). Cyclosporine (Cy) was responsible for diastolic hypertension, renal dysfunction, hirsutism, hyperplasia of the gingiva, hepatic dysfunction, and seizures. The survival rate of the Cy-treated patients was 68% at 7 years. All survivors have virtually normal social and professional lives, included the longest survivor 14 years after the operation. Recently in 34 patients in acute irreversible cardiac failure and who cannot have a transplant in time, we implant a total artificial heart (TAH) type JARVIK 7 during a period from 1-150 days. There has been no mechanical failure, hemolysis or thrombo-embolism and only one right ventricular device malposition; 20 patients died before transplantation, 13 were successfully transplanted, 1 is still on the artificial heart. Heart transplantation, and TAH used as a bridge to transplantation are now an accepted therapeutic means for irreversibly cardiac failure in selected patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Current problems in cardiac transplantation. 266 Sep 20

To explain the progression from infectious viral myocarditis to congestive cardiomyopathy an infection/immune hypothesis has been proposed stating that the primary viral process incites an excessive or disordered immunologic response against the myocardium. To test whether one form of immunosuppressive therapy might ameliorate this process, we used cyclosporine in a murine preparation of infectious myocarditis (encephalomyocarditis [EMC] virus), which has been shown to result in a congestive cardiomyopathy pathologically similar to that seen in man. Eight-week-old male DBA-2 mice were infected with EMC virus and randomized to a treatment or control group. Cyclosporine (25 mg/kg/day) was administered subcutaneously for 3 weeks, starting (1) at 1 week after infection during viral replication, and (2) at 3 weeks after infection, after the period of active viral replication. In mice treated during viral replication there was a significantly higher mortality rate compared with that of control mice (15/21 vs 9/29, p = .01). There was no evident reduction in myocardial pathology (inflammation, necrosis, or calcification) in the treated compared with the control groups. In mice treated after the period of viral replication, there was no improvement in mortality (8/22 vs 2/19, NS) compared with control. Treated mice showed no reduction in myocardial histopathologic lesions. Furthermore, treated mice had significantly greater heart weight/body weight ratios (1.3 +/- 0.4% vs 1.0 +/- 0.3%, p less than .005), lung weight/body weight ratios (1.1 +/- 0.5% vs 0.8 +/- 0.3%, p less than .05), and liver weight/body weight ratios (6.0 +/- 0.8% vs 5.4 +/- 0.6%, p less than .005) than control mice, suggesting more severe myocardial failure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Therapy with cyclosporine in experimental murine myocarditis with encephalomyocarditis virus. 369 28

Cardiac transplantation is now accepted as the therapy of choice for irreversible, advanced heart failure. Improving results have been observed since 1980. This is the consequence of better defined criteria for selection of recipients, refined use of antilymphocyte serum, improved myocardial preservation methods, and the introduction of cyclosporine. Cyclosporine, a metabolite of a soil fungus, is one of the most potent and specific immunosuppressants yet discovered. Its main drawbacks are nephrotoxicity and hepatotoxicity. The immunosuppressive protocol usually includes cyclosporine and low dose steroid. Overall one-year survival has reached 80% to 85%, with a two-year survival of 65% to 75%. The incidence of rejection remains stable despite the use of cyclosporine, but rejection-related morbidity and mortality have been decreasing since 1980. Endomyocardial biopsy of the right ventricle provides good morphologic criteria for assessing the degree of rejection. The absence of myocardial edema during rejection in cyclosporine treated patients appears to be responsible for the limited hemodynamic deterioration and electrographic changes. Morbidity and mortality due to infection have been reduced with cyclosporine, as well. Lymphoma is still common after heart transplantation and may be related to high cyclosporine doses used in the beginning of the clinical trials. Accelerated coronary atherosclerosis of the graft is now the major factor limiting long-term survival and is probably related to chronic rejection. Human heart-lung transplantation began in 1981 at Stanford after excellent clinical results with cardiac transplantation. The success of early attempts was attributed to the use of cyclosporine and the use of combined heart-lung replacement.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Heart transplantation. 389 77

In July 1983, a heart transplant program was initiated. Up to September 1985, 72 orthotopic transplants in 69 patients (62 men, 7 women, age 9 to 55 years, mean 40.1 years) have been performed. All patients suffered from end-stage heart failure, which was due to coronary artery disease in 15 patients, congestive cardiomyopathy in 53 patients and endocardial fibrosis in one woman. All patients survived the operation, but there were 6 deaths within the first 30 postoperative days. Eight more patients died subsequently. Causes of death were rejection in 6, infection in 3, cerebral hemorrhage in 2, sudden death in 2 and pulmonary embolism in one patient. Actuarial survival at one and two years was calculated at 75%. The detection of allograft rejection was the major postoperative problem. This was achieved by serial endomyocardial biopsy and myocardial voltage monitoring via a telemetry pacemaker system. The lowest rate of organ toxicity, rejection and infection was achieved using a triple immunosuppressive regime including Azathioprine, Cyclosporine A and steroids with initial doses of antithymocyte globulin. It is concluded that heart transplantation can be regarded as a routine procedure for patients with intractable heart failure. The operative risk is limited, and an elaborate immunosuppressive regimen makes long-term survival possible without obvious allograft deterioration. Cardiac transplantation should be seriously considered in patients under 55 years, who suffer from life-threatening heart failure not amenable to other modes of therapy.
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PMID:Heart transplantation--a two-year experience. 391 80

Severe heart failure developed in a 49-year-old patient 18 months after orthotopic cardiac transplantation. Acute rejection as well as other overt causes of graft failure were excluded. Haemodynamic measurements suggested severe diastolic myocardial dysfunction. Since no other causes of diastolic heart failure were identified, a potential side effect from cyclosporine was considered. Cyclosporine was therefore withdrawn and immunosuppressive treatment was switched to conventional therapy consisting of azathioprine and prednisolone. Withdrawal of cyclosporine was followed by an impressive clinical improvement and by complete haemodynamic normalization. Therefore, in cases of otherwise unexplained graft failure, a potentially reversible side effect from cyclosporine should be taken into consideration.
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PMID:Relief of diastolic cardiac dysfunction after cyclosporine withdrawal in a cardiac transplant recipient. 832 17


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