Left ventricular pressure measurement by telemetry is an effective means to evaluate transplanted heart function in experimental heterotopic cardiac xenotransplantation.
Left ventricular pressure measurement by telemetry is an effective means to evaluate transplanted heart function in experimental heterotopic cardiac xenotransplantation.
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DOI：
10.1016/j.transproceed.2010.05.117
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发表时间：
2010-07
影响因子：
0.9
通讯作者：
Mohiuddin, M. M.
中科院分区：
文献类型：
--
作者：
Horvath, K. A.;Corcoran, P. C.;Singh, A. K.;Hoyt, R. F.;Carrier, C.;Thomas, M. L., III;Mohiuddin, M. M.
异位心脏移植的功能评估传统上是通过手动触诊或连续活检来完成的。这两种方法都有缺点。触诊可能很难区分来自移植物的脉搏和来自自然主动脉的传输脉搏。连续活组织检查虽然准确，但需要多次剖腹手术，导致发病率增加，可能还会导致死亡率。在这项研究中，我们使用了一种先进的遥测系统，由腹内植入物组成，能够同时连续监测移植心脏的几个参数和受者的状态。在一个异位心脏移植的大型动物模型(猪供体到狒狒受体)中，我们将该装置植入了12只动物：8只有免疫抑制，4只没有免疫抑制。我们监测并持续记录移植心脏的左心室压力(收缩峰值和舒张末[LVEDP])、心率、心电图类型以及受体的体温。左心室压力是评价移植物心脏功能的最有价值的参数。在4例非免疫抑制的病例中，移植物被急性排斥。在这些病例中，当收缩压和舒张压之差降至10毫米汞柱时，舒张末压力急剧增加，心脏停止收缩。排斥反应的最早可复制迹象是LVEDP增加。在长期存活的患者中，舒张压的增加是逐渐的，这表明心肌逐渐增厚，心室顺应性降低。8只免疫抑制的动物中有6只在排斥移植心脏之前死于其他并发症。遥测还有助于提示受者早期发烧，从而使我们能够及早干预并预防潜在的致命败血症并发症。通过遥测连续监测几个参数，可以在早期阶段检测到与排斥反应相关的变化以及其他并发症，从而能够及时干预、治疗，并可能逆转排斥反应。
Evaluation of the function of heterotopic cardiac transplants has traditionally been accomplished by either manual palpation or serial biopsies. Both methods have drawbacks. Palpation can be difficult to differentiate a pulse from the graft versus a transmitted pulse from the native aorta. Serial biopsies, though accurate, require multiple laparotomies, leading to increased morbidity and possibly mortality rates. In this study we used an advanced telemetry system, consisting of an intra-abdominal implant, that was capable of continuously monitoring simultaneously several parameters of the transplanted heart and the status of the recipient. In a large animal model of heterotopic cardiac xenotransplantation (pig donor to baboon recipient), we implanted the device in 12 animals: 8 with and 4 without immunosuppression. We monitored and continuously recorded the left ventricular pressure (both peak-systolic and end-diastolic [LVEDP]), heart rate, and the electrocardiogram pattern of the transplanted heart as well as the temperature of the recipient. The left ventricular pressure proved to be the most valuable parameter to assess graft heart function. In the 4 nonimmunosuppressed cases, grafts were rejected acutely. In these cases, the end-diastolic pressure increased sharply and the heart stopped contracting when the difference between the systolic and the diastolic pressure decreased to <10 mm Hg. The earliest reproducible sign of rejection was an increased LVEDP. Among long-term survivors, the increase in diastolic pressure was gradual, indicating progressive thickening of the myocardium and decreased compliance of the ventricle. Six of 8 immunosuppressed animals died of other complications before rejecting the transplanted heart. The telemetry was also helpful to indicate early onset of fever in the recipients, thus allowing us to intervene early and prevent potentially lethal septic complications. Continuous monitoring of several parameters via telemetry allowed detection of changes associated with rejection as well as other complications at an early stage, allowing prompt intervention, treatment, and possibly reversal of rejection.
影响因子：
4.6
作者：
Adams, DH;Chen, RH;Naficy, S
通讯作者：
Naficy, S
影响因子：
8.9
作者：
Chen, RH;Kadner, A;Adams, DH
通讯作者：
Adams, DH
影响因子：
2.2
作者：
GROENEVELD, WH;KORT, WJ
通讯作者：
KORT, WJ