Lowry R W, Bitar J N, Grinstead W C, Young J B, Noon G P, Vardan S, Cocanougher B, Kleiman N S
Multiorgan Transplant Center, Methodist Hospital, Baylor College of Medicine, Houston, Texas.
Cathet Cardiovasc Diagn. 1994 May;32(1):18-26. doi: 10.1002/ccd.1810320105.
Follow-up after heart transplantation presently requires invasive techniques to assess graft viability and function. As the heterotopic transplant technique assumes a more important therapeutic role for patients not eligible for an orthotopic allograft, an understanding of the inherent challenges associated with management of these patients is mandatory to optimize patient care. Heterotopic transplant technique was used in 19 of 135 (14%) consecutive heart transplant procedures over a 41 month period. Invasive diagnostic procedures performed in follow-up revealed 1) adequate tissue for histologic evaluation in 140/158 (89%) biopsy procedures, 2) successful pulmonary wedge pressure measurements in 142/158 (90%) right heart catheterizations, and 3) successful coronary arteriography in 18 patients undergoing angiography (both vessels in 12 and one vessel in six patients). Thus, biopsy and surveillance procedures are feasible and productive in patients who have undergone heterotopic heart transplantation.
Although heterotopic heart transplantation has become an increasingly utilized therapy for some patients with heart failure, there are no guidelines for routine biopsy and angiographic techniques in these patients. The objective of this study was to determine the feasibility of angiographic and endomyocardial biopsy procedures in heterotopic heart transplant recipients.
The complete experience with heterotopic heart transplant recipients at Baylor College of Medicine and The Methodist Hospital over a 41 month period including endomyocardial biopsy, right heart catheterization, and selective coronary arteriography results were analyzed.
Eighteen patients underwent 310 procedures without significant complications. Of 158 biopsy procedures, 140 (89%) yielded tissue adequate for histologic evaluation. Right heart pressures were obtained in almost all patients undergoing right heart catheterization. Pulmonary wedge pressures were obtained in 137 (90%). A rapid decrease in right heart pressures was noted following transplant; however, a gradual but significant rise in mean arterial pressure occurred. Eighteen selective coronary arteriogram procedures were performed; 12 (66%) resulted in successful cannulation of both coronary arteries. Of 12 patients followed for at least 1 year, five (40%) have developed evidence of allograft arteriopathy. The 1 and 2 year survival rates were 67% and 53%, respectively.
Invasive diagnostic techniques can be performed safely and reliably and should not preclude the use of heterotopic heart transplantation in selected patients who are otherwise unsuitable for orthotopic transplantation.
目前心脏移植后的随访需要采用侵入性技术来评估移植物的活力和功能。由于异位移植技术对于不符合原位同种异体移植条件的患者发挥着越来越重要的治疗作用，因此必须了解与这些患者管理相关的固有挑战，以优化患者护理。在41个月的时间里，135例连续心脏移植手术中有19例（14%）采用了异位移植技术。随访中进行的侵入性诊断程序显示：1）在158例活检程序中有140例（89%）获得了足够用于组织学评估的组织；2）在158例右心导管检查中有142例（90%）成功测量了肺楔压；3）在18例接受血管造影的患者中成功进行了冠状动脉造影（12例患者双侧血管造影成功，6例患者单侧血管造影成功）。因此，活检和监测程序在接受异位心脏移植的患者中是可行且有效的。
尽管异位心脏移植已越来越多地用于某些心力衰竭患者的治疗，但对于这些患者的常规活检和血管造影技术尚无指南。本研究的目的是确定血管造影和心内膜活检程序在异位心脏移植受者中的可行性。
分析了贝勒医学院和卫理公会医院在41个月期间对异位心脏移植受者的完整经验，包括心内膜活检、右心导管检查和选择性冠状动脉造影结果。
18例患者接受了310项手术，无明显并发症。在158例活检程序中，140例（89%）获得了足够用于组织学评估的组织。几乎所有接受右心导管检查的患者都获得了右心压力数据。137例（90%）获得了肺楔压数据。移植后右心压力迅速下降；然而，平均动脉压逐渐但显著升高。进行了18例选择性冠状动脉造影程序；12例（66%）成功插管双侧冠状动脉。在12例随访至少1年的患者中，5例（40%）出现了移植物动脉病变的证据。1年和2年生存率分别为67%和53%。
侵入性诊断技术可以安全可靠地进行，对于其他方面不适合原位移植的特定患者，不应排除使用异位心脏移植。
