[Cardiac transplantation; results after 5 years].

After cardiac transplantation, long-term results were assessed in a group of 46 patients who survived more than 5 years after surgery. They were the survivors (50%) of a group of 92 patients who underwent transplantation before January 1990. On January 1995, mean follow-up was 82 +/- 14 months.

Early impairment of acetylcholine-induced endothelium-dependent coronary vasodilation is not predictive of secondary graft atherosclerosis.

Study Objective: To test the hypothesis that the magnitude of early constriction of coronary arteries to acetylcholine might be a useful predictor of secondary graft atherosclerosis.

Design: The responses of epicardial coronary arteries to stepwise intracoronary infusion of acetylcholine (10(-8)M to 10(-5)M) were compared in 7 control subjects and in 18 patients who had undergone transplants within 2 months after surgery.

Measurements And Results: Vessel dimensions (percent basal diameter) were measured by quantitative angiography.

[Cardiac surgery in chronic hemodialysed patients: immediate and long-term results].

Between 1979 and 1993, 50 patients (33 men and 17 women) receiving chronic haemodialysis, underwent 53 cardiac surgical procedures in the department. The mean age was 56 +/- 13 years. The average duration of preoperative dialysis was 82 +/- 63 months.

Donor/recipient aorta size mismatch in heart transplantation: a technical alternative.

A technical alternative is proposed to enable transplantation in cases of considerable size mismatch between donor and recipient aorta: interposition of a Dacron graft of intermediate diameter. This procedure was performed in a 56-year-old patient weighing 75 kg in whom a heart from a 40-kg donor was implanted.

[Cardiac transplantation. Operative risk factors].

An evaluation of the risks of heart transplantation, and in particular operative risk factors, should lead to optimal decision making in light of the lack of sufficient supply of transplantable organs. The optimal recipient for transplantation is the patient who will benefit best from the organ in terms of survival and quality of life and for whom the operative risk is the smallest. This study emphasized the preparing role of donors over 45, the poorer prognosis in recipients over 60, the situations limited by pulmonary resistance and the notion of retransplantation.

[Coronary reoperations: indications and results].

The aim of this study was to assess the results of coronary reoperations and to determine the indications. Between January 1972 and December 1990, 166 coronary reoperations were performed in 161 patients (5 patients were operated three times). The interval between the first and second operation was 93 +/- 46 months.

[Aprotinin in cardiac surgery in patients with platelet anti-aggregant treatment].

A large number of coronary patients referred for coronary bypass surgery receive platelet anti-aggregant therapy which has the disadvantage of increasing per and postoperative haemorrhage. The aim of this study was to assess the effects of aprotinin in 60 patients under platelet antiaggregant therapy (aspirin 250 mg/day) for over 30 days before surgery for coronary bypass grafting. The clinical (age, weight, diagnosis, bypass time, number of grafts) and biological features (preoperative haemoglobin concentration, platelet count and fibrinogen levels) were identical in a group treated by aprotinin (Group A, n = 30) and a control group (Group B, n = 30).

Effects of plasma lipid levels on blood distribution and pharmacokinetics of cyclosporin A.

The present study attempted to characterize the distribution of cyclosporin A (CsA) among the lipoprotein fractions, very-low-, intermediate-, low-, and high-density (VLDL, IDL, LDL, and HDL, respectively) in the plasma of patients awaiting heart transplantation and the influence of plasma lipid constituents on the pharmacokinetics of CsA. Major fractions of a therapeutic concentration of CsA were found in HDL and in LDL. In addition, plasma lipid concentrations (total cholesterol, triglycerides, phospholipids, VLDL-cholesterol--TC, TG, PL, VLDLc, respectively) are positively correlated with the CsA distribution within the LDL fraction, and negatively correlated with the CsA distribution within the HDL fraction.

Acetylcholine-induced constriction of angiographically normal coronary arteries is not time dependent in transplant recipients. Effects of stepwise infusion at 1, 6, 12 and more than 24 months after transplantation.

Objectives: The aim of this study was to evaluate whether acetylcholine may be a useful tool for detection of early angiographically undetectable coronary atherosclerosis in heart transplant recipients.

Background: Coronary artery disease is the main determinant of long-term prognosis in transplant recipients. Acetylcholine-induced constriction of angiographically normal coronary arteries in heart transplant recipients could be due to early atherosclerosis, and acetylcholine has been proposed for early detection of coronary artery disease.

Mitroflow pericardial valve: long-term durability.

Isolated aortic (n = 107), mitral (n = 63), and tricuspid (n = 1) valve replacement and 28 double-valve replacements were performed with a second generation of pericardial valves, the Mitroflow valve, in 199 patients from March 1983 to December 1986. Follow-up (total, 1,058 patient-years) was extended to 106 months and 91.5% complete.

Preservation of the aortic valve in acute aortic dissection: long-term echocardiographic assessment and clinical outcome.

The aim of the present study was to determine the long-term status of the native aortic valve after surgical treatment of acute aortic dissection involving the ascending aorta. From 1972 to 1991, 93 patients underwent operation for type I or II aortic dissection. There were 76 men and 17 women.

[Preservation of the aortic valve in acute dissection of the ascending aorta].

The aim of this study was to evaluate the status of the native aortic valve in patients operated for acute dissection of the ascending. aorta (ADAA). Between November 1972 and November 1991, 93 patients were operated for ADAA.

Pharmacological bridge to cardiac transplantation: current limitations.

Addition of intravenous enoximone to sympathomimetic agents permits a rapid and drastic improvement in the clinical and hemodynamical condition of patients in cardiogenic shock referred for a mechanical bridge to transplantation. The present experience, based on the management of 52 patients, permits us to point out the current limitations of this pharmacological bridge: the rate of sudden death, the incompleteness of the physical rehabilitation of the patients, and the vanishing effect of intravenous enoximone.

[Simultaneous heart and kidney transplantation using the same donor].

From 1988 to 1991, five cases of combined heart and kidney transplantation using the same donor have been achieved at our institution. All patients were males, 58 +/- 6 (46 to 64). The cardiac condition leading to the cardiac replacement was a dilated cardiomyopathy in one case, end-stage ischemic disease in 3, and failure of a previous cardiac transplantation in one.

Effects of time and previous acute rejection episodes on coronary vascular reserve in human heart transplant recipients.

Objectives: This study examined whether previous rejection episodes may have deleterious effects on coronary vascular reserve of heart transplant recipients months after transplantation.

Background: Coronary reserve has been demonstrated to be within the normal range in long-term transplant patients without previous episodes of rejection. Conversely, acute rejection is associated with a dramatic reduction of coronary reserve, which is rapidly restored after therapy.

[Can solid state Holter monitoring replace endomyocardial biopsy in patients with heart transplantation?].

Acute cardiac graft rejection after transplantation, the diagnosis of which is based on the findings of endomyocardial biopsy, is associated with a reduction in coronary reserve due to abnormalities of the microcirculation. But this reduction in coronary reserve cause silent myocardial ischaemia (SMI)? In order to assess the frequency of SMI and ventricular arrhythmias during rejection, 53 consecutive Holter recordings were performed in 32 patients (28 men, 4 women, average age 47 +/- 11 years) 11 months after transplantation and within 24 hours of endomyocardial biopsy. The recorder which was used (Monitor One TC) analysed the ST segment in 2 leads in real time: ST segment depression of more than 1 mm lasting over 40 ms, 0.

Evaluation of direct effects of enoximone on systemic and pulmonary vascular bed in animals with a Jarvik total artificial heart.

Enoximone, a phosphodiesterase inhibitor, has positive inotropic and vasodilating actions. To evaluate specific effects of this drug on the systemic and pulmonary vascular bed, we administered enoximone as a 10-minute intravenous bolus at two different doses of 2 and 3 mg/kg of body weight, at different days, to five Holstein calves with a Jarvik 7-70 ml total artificial heart (Symbion, Inc., Salt Lake City, Utah).

[Emergency aorto-coronary bypass after myocardial infarction].

During a recent three-year period, 37 patients had an emergent aortocoronary bypass (ACB) after evolutive acute myocardial infarction. The patients are divided up into two groups: group I includes 12 patients who were operated after the failure of early thrombolysis; group II includes 25 patients operated after the failure of revascularization through percutaneous angioplasty. In group I, all patients survived and 9 had no postoperative complications.

[Reduction of per- and postoperative blood loss with aprotinin (Trasylol) during extracorporeal circulation].

Aprotinin is a pharmacological agent which, when given in high doses during cardiopulmonary bypass (CPB), seems to reduce postoperative blood loss significantly and thereby reduces the need for blood transfusion. This study was undertaken to confirm these claims and to show that there was also decreased peroperative bleeding and a shorter operation time. The immediate postoperative clinical course was also assessed.

[Coronary vascular reserve in heart transplantation. Normalization after therapy for rejection].

Acute rejection is associated with severe impairment of coronary reserve in heart transplants. To evaluate the effects of rejection therapy, coronary reserve was assessed in 6 patients before and after treatment of an acute episode of rejection. Coronary reserve was significantly enhanced after rejection therapy (4.

Acute postinfarction septal rupture: long-term results.

From 1973 to 1989, 66 patients received early surgical repair for acute postinfarction ventricular septal rupture. Mean age was 64 +/- 7 years (range, 45 to 80 years). Ventricular septal rupture occurred soon after acute myocardial infarction (3.

Intraoperative transesophageal echocardiography for pulmonary embolectomy without cardiopulmonary bypass.

This case report describes a patient with massive pulmonary embolism and acute circulatory failure in whom transesophageal echocardiography permitted the diagnosis of thrombi in the main pulmonary truncus and in the right branch and guided intraoperatively the surgical embolectomy performed under simple venous inflow occlusion because of a contraindication to heparin administration. Transesophageal echocardiography seems to be a very helpful technique to diagnose promptly massive pulmonary embolism and a very useful tool at the time of operation to guide the embolectomy.

[Heart transplantation in acute myocardial infarction].

Ten patients with cardiogenic shock after acute myocardial infarction were referred to the University Hospital Henri Mondor as candidates for cardiac transplantation. The period before transplantation was bridged by maximal pharmacological support including sympathomimetic and phosphodiesterase inhibitor inotropic agents and, in non-responders, by mechanical ventricular assist devices (1 case) or artificial hearts (2 cases). The 7 patients who improved with optimal pharmacological support alone had a good initial course.