Long term function of the transplanted heart.

Citation
E. Tatou et al., Long term function of the transplanted heart., ARCH MAL C, 93(6), 2000, pp. 703-709
Citations number
17
Language
FRANCESE
art.tipo
Article
Categorie Soggetti
Cardiovascular & Respiratory Systems
Journal title
ARCHIVES DES MALADIES DU COEUR ET DES VAISSEAUX
ISSN journal
0003-9683 → ACNP
Volume
93
Issue
6
Year of publication
2000
Pages
703 - 709
Database
ISI
SICI code
0003-9683(200006)93:6<703:LTFOTT>2.0.ZU;2-Q
Abstract
The aim of this study was to identify the long-term haemodynamic changes of the transplanted heart. Between 1987 and 1997, 136 patients required cardiac transplantation at Dij on hospital. During follow-up, 76 patients aged 51.2+/-9.46 years underwent catheter studies (12 women, 15.8%; and 64 men, 84.2%). Right and left heart catheterisation was performed at 3 months, 1, 2, 3 and 5 years after transplantation. Right heart catheterisation included measur ement of mean pulmonary artery and pulmonary capillary pressures and pulmon ary arteriolar resistances. During left heart catheterisation, cardiac outp ut, mean aortic pressure, the ejection fraction, the dp/dt max of the left ventricular wall, systemic arterial resistances and left ventricular end di astolic pressures were measured. At each catheter study, the indexed myocar dial mass, indexed end systolic and end diastolic left ventricular volumes, the mass/volume ratio, the residual serum ciclosporine concentrations and the serum creatinine were analysed. In addition, an endomyocardial biopsy w as also performed. Initially raised, the mean pulmonary artery and pulmonary capillary pressur es decrease from the 3rd month to the 2nd year. From the 3rd year onwards, they readjust to the upper limits of normal. The pulmonary artery resistanc es underwent the same changes. The left heart parameters remained constant over the period of follow-up bu t with a heart rate, mean aortic pressure and left ventricular end diastoli c pressure higher than normal. The indexed myocardial mass was increased at all periods. The indexed left ventricular end systolic and diastolic volum es decreased with a M/V ratio which increased. Ciclosporine concentrations decreased whereas serum creatinine increased. The frequency of severe rejec tion and of coronary atherosclerosis was low. Significant correlations were observed between different parameters at different periods. In the long-te rm, the function of the transplanted heart is not normal in the strict sens e of the term. The apparent normality is obtained by anti-hypertensive trea tment. The transplanted heart adapts to the increase in ciclosporine-induce d afterload by permanent myocardial hypertrophy, and increased diastolic pr essure probably relates to diastolic dysfunction without noticeable intraca rdiac fibrosis.