HEMODYNAMIC OBSERVATIONS ONE AND 2 YEARS AFTER CARDIAC TRANSPLANTATION IN MAN
HEMODYNAMIC OBSERVATIONS ONE AND 2 YEARS AFTER CARDIAC TRANSPLANTATION IN MAN
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DOI：
10.1161/01.cir.45.6.1183
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发表时间：
1972-01-01
期刊：
影响因子：
37.8
通讯作者：
GRIEPP, RB
中科院分区：
文献类型：
--
作者：
STINSON, EB;SHUMWAY, NE;GRIEPP, RB
8例患者在心脏移植后1年进行了心导管检查，其中2例在2年时再次进行。术后1年和2年，所有患者的静息心内压均正常。平均心脏指数在休息时在1年为2.3升/分钟/平方米，平均心率为90次/分钟。反应戊基亚硝酸盐，阿托品，酪胺未能证明传出自主神经再支配的供体心脏。移植术后1年进行10分钟次极量仰卧位自行车运动的结果包括：（1）在大部分运动期间心率逐渐升高，（2）左室舒张末期压迅速升高，平均升高10 mm Hg，部分患者在运动后期下降;（3）左室收缩压在整个运动期的前半部分逐渐增加，（4）左室压力变化率（dp/dt）在整个运动期间持续正变化，（5）每搏输出量平均增加44%，（6）左室收缩压在整个运动期间逐渐增加，（7）左室收缩压在整个运动期间持续正变化，（8）左室收缩压在整个运动期间持续正变化，（9）左室收缩压在整个运动期间持续正变化，（10）左室收缩压在整个运动（6）心输出量平均增加92%。运动期间心输出量对摄氧量的回归斜率在正常范围内。然而，心输出量低于正常，在休息和运动期间，动静脉氧difrerence相应地扩大。在一个病人研究移植后1年和2年，血流动力学的结果是可比的两个场合。然而，在另一组中，与1年相比，2年时对运动的心输出量反应明显减弱，这几乎完全是由于每搏输出量未能增加。冠状动脉造影显示，在这个受体的闭塞性冠状动脉疾病的证据与移植物动脉粥样硬化兼容。这些研究表明，移植的人类心脏的持续能力，以支持正常的体力活动在术后后期。虽然利用失神经心脏的非典型适应机制的特点，移植的心脏在一个方向上适当的方式来响应运动的代谢需求。
Cardiac catheterization studies were performed in eight patients 1 year after cardiac transplantation and in two of these again at 2 years. Intracardiac pressures at rest were normal in all patients, both 1 and 2 years postoperatively. Average cardiac index at rest at 1 year was 2.3 liters/min/m2and average heart rate was 90 beats/min. Responses to amyl nitrite, atropine, and tyramine failed to demonstrate efferent autonomic reinnervation of the donor hearts. Findings associated with a 10-min period of submaximal supine bicycle exercise 1 year after transplantation included: (1) a gradual rise in heart rate throughout most of the exercise period; (2) prompt elevation of left ventricular end-diastolic pressure by an average increment of 10 mm Hg, followed by a decrease during late exercise in some patients; (3) a progressive increase in LV systolic pressure throughout the first half of the exercise period; (4) a continuously positive change in LV rate of pressure change (dp/dt) throughout exercise; (5) an average 44% increase in stroke volume; and (6) an average 92% increase in cardiac output. The slope of the regression of cardiac output on oxygen uptake during exercise was within the range of normal. Cardiac output, however, was lower than normal both at rest and during exercise, and the arteriovenous oxygen diflerence was accordingly widened.In one patient studied 1 and 2 years after transplantation, hemodynamic findings were comparable on both occasions. In the other, however, the cardiac output response to exercise was distinctly diminished at 2 years as compared to 1 year, due almost entirely to failure of the stroke volume to increase. Coronary arteriography in this recipient revealed evidence of occlusive coronary disease compatible with graft atherosclerosis.These studies demonstrate the sustained capacity of the transplanted human heart to support normal physical activity late in the postoperative period. Although utilizing atypical adaptive mechanisms characteristic of the denervated heart, the transplanted heart responds in a directionally appropriate manner to the metabolic demands of exercise.