Kitamura M, Sakakibara N, Kurosawa H, Imamura E, Kasanuki H, Sekiguchi M, Koyanagi H
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo.
J Heart Transplant. 1988 May-Jun;7(3):213-21.
This study was undertaken to electrophysiologically find signs of rejection after heart transplantation. A donor heart with a created atrial septal defect was implanted in the retroperitoneal space by anastomosing the thoracic aorta and left pulmonary artery of the donor heart to the abdominal aorta and inferior vena cava of the recipient heart, respectively. Endocardial leads were set up in the right atrium in the vicinity of the bundle of His and in the right ventricle. Cyclosporine (10 to 18 mg/kg/day, continuously) and prednisolone (1.0 mg/kg/day, for the first 4 days) were given orally. Electrophysiologic examinations were performed 1 to 4 days (control data) after the transplantation and were compared with data obtained 5 to 21 days after operation on 12 mongrel dogs. Finally, histopathology of the donor heart was studied. Results showed that the effective refractory period (ERP) of the atrioventricular conduction system was prolonged in six animals from 120 +/- 25 to 192 +/- 35 msec (p less than 0.02) on average. The ERP of the ventricle was shortened in four dogs from 153 +/- 36 to 123 +/- 17 msec (p less than 0.05). Specimens disclosed mononuclear cell infiltration in the atrioventricular node, the bundle of His, and the right and left bundle branches in eight of 12 cases and mild to moderate myocyte damage with cell infiltration in the ventricular septum of the same eight hearts. The ERP of the atrioventricular conduction system showed no change in four cases without mononuclear cell infiltration in the conduction system. These results suggested the feasibility of electrophysiologic monitoring as a means for detecting acute rejection in the prenecrotic stage in transplanted hearts.
本研究旨在通过电生理方法寻找心脏移植后排斥反应的迹象。将带有人工房间隔缺损的供体心脏植入腹膜后间隙，分别将供体心脏的胸主动脉和左肺动脉与受体心脏的腹主动脉和下腔静脉吻合。在希氏束附近的右心房和右心室内设置心内膜电极。口服环孢素（10至18毫克/千克/天，持续用药）和泼尼松龙（1.0毫克/千克/天，用药前4天）。在移植后1至4天进行电生理检查（对照数据），并与12只杂种犬术后5至21天获得的数据进行比较。最后，对供体心脏进行组织病理学研究。结果显示，12只动物中有6只的房室传导系统有效不应期（ERP）平均从120±25毫秒延长至192±35毫秒（p<0.02）。4只犬的心室ERP从153±36毫秒缩短至123±17毫秒（p<0.05）。标本显示，12例中有8例在房室结、希氏束以及左右束支有单核细胞浸润，同样是这8颗心脏的室间隔有轻度至中度的心肌细胞损伤及细胞浸润。传导系统无单核细胞浸润的4例中，房室传导系统的ERP无变化。这些结果表明，电生理监测作为检测移植心脏坏死前期急性排斥反应的一种手段是可行的。
