Electrophysiologic and Histopathologic Evaluation of the Transplanted Heart

移植心脏的电生理学和组织学评价材料和方法刘易斯（LEW/Crj）是同系移植物的供体或刘易斯（LEW/Crj ; n=6）或Wistar King（WKAH/HKm ; n=12）受体。采用Ono和Lindsey方法，在250 ~ 300 g雄性近交系成年大鼠腹腔内进行心脏移植（Tx）。应用程序外刺激法（基本周期为150 msec），分别于治疗后早期（第2天）、中期（第7- 9天）和晚期（第11- 14天）检测ERP-AVCS，并于末次ERP结束时对传导系统和室间隔进行病理学检查。同基因Tx的对照组（LEW/Crj大鼠之间：n=6）没有免疫抑制剂。同种异体Tx组（LEW/Cri WKAH/HK m ; n=12）用环孢霉素（10 mg/kg/天）处理直至处死，该组中的6只大鼠给予泼尼松龙（I. 0 mg/kg/天）口服 ...更多信息 术后第2周，对照组ERP-AVCS和组织病理学检查均无变化。在同种异体Tx组的所有病例中，第7 ~ 9天获得的ERP-AVCS个体值比第2天升高20%或更高。这一变化具有统计学意义，第2天的平均<plus-minus>SD为<plus-minus>84.6毫秒，<plus-minus>第7-9天为108.10毫秒（p&lt;0.01）。其中，6个心脏在中等ERP研究后进行了检查，显示单核细胞浸润，特别是在传导系统中，没有心肌细胞坏死。其余6只大鼠在第11-14天的ERP-AVCS恢复至第2天获得的初始值，在10%范围内。他们的标本显示较少的主要细胞浸润。1例同种异体移植物的ERP-AVCS（Oo. 9)有代表性。ERP-AVCS由移植后第2天的84毫秒延长至第7天的114毫秒，术后恢复至88毫秒。结论ERP-AVCS延长可作为诊断心脏移植术后免疫抑制治疗前轻度急性排斥反应的一个有用指标。这提供了在心脏移植后的前四至六周期间，当适当的心外膜经皮电极就位时，电生理监测可能适合使用。少

Electrophysiologic and Histopathologic Evaluation of the Transplanted HeartMATERIALS AND METHODSLewis (LEW/Crj) were donors of isografts or Lewis (LEW/Crj ; n=6) or Wistar King (WKAH/HKm ; n=12) recipients. Intra-abdominal heart transplantation (Tx) was performed by the method of Ono and Lindsey in adult male inbred rats (250 to 300g).The hook-tipped bipolar endocardial leads were set up in the right atrial and right ventricular walls. ERP-AVCS was asseeed by programed extrastimulus method (basic cycle length of 150 msec) in early (2nd day), medium (7-9th day) and late (11-14th day) post-Tx periods.Specimens of the conduction system and vetricular septum were examined liistopathologically at the end of final ERP study. A control group of isogenic Tx (between LEW/Crj rats : n=6) had no immunosuppressant. The allogenic Tx group (LEW/Cri WKAH/HK m ; n=12) was treated with cyclosporine (lOmg/kg/day) until sacrificed and six rats of this group were given prednisolone (I. 0 mg/kg/day) orally … More on the second postoperative week.RESULTSControl group showed no change in both ERP-AVCS and histopathologic findings. Individual values of ERP-AVCS obtained in days seven to nine were elevated 20% or higher than those of day two in all cases of allogenic Tx group. This change was statistically significant ; mean <plus-minus> SD were 84 <plus-minus> 6 msec on day two to 108 <plus-minus> 10 msec on day 7-9(p<0.0 1). Of these, six hearts were examined after medium ERP study, showing mononuclear cell infiltration without myocyte necrosis especially in the conduction system. ERP-AVCS of the remaining six rats on day 11-14 was recovered to initial values obtained on day two within 10% range. Their specimens showed less predominant cell infiltration. Tlie ERP-AVCSs of one allograft (Oo. 9) are represented. The ERP-AVCSof this heart was prolonged from 84 msec on post-Tx day two to 114 msec on day 7 and recovered to 88 msec on postoperative dCONCLUSIONSThese results suggest that the prolongation of ERP-AVCS could be a useful paramenter for diagnosing mild acute rejection in the prenecrotic stage under immunosuppressive treatment following heart transplantation. This offers that the electrophysiologic monitoring may be suitable for use during the first four to six weeks after heart transplantation, while the appropriate epicardial transcutaneous electrodes are in place. Less