Multiple basic research for clinical application of the heart and heart-lung transplantation

进行了四项研究，以评估心脏或心肺移植的主要问题。注血-中流量体外循环下避免溶血和防止肺水肿对实验性原位心脏移植具有重要意义。供体心脏收缩压/收缩压容积比在移植后立即下降。术后早期移植心脏的导电性和难熔性无明显变化。我们制作了自己的实用手册，内容涉及供体心脏的摘取、保存和原位移植技术以及受者的围手术期护理。对移植犬心脏的电生理评价表明，房室传导系统有效不应期的延长对传导系统细胞浸润具有显著的敏感性。这些结果表明电生理监测作为一种检测移植心脏坏死前急性排斥反应的手段是可行的。犬同种异体单肺移植的肺血流阻力关系表明，同种异体肺移植的肺血流阻力在正常肺血流的2倍以内，能很好地耐受正常肺血流。提示单肺移植是治疗肺动脉高压的有效方法。人工表面活性剂处理组与未处理组相比，肺与心脏保存4小时后具有更好的总顺应性和更小的气-血屏障损伤。提示人工表面活性剂的补充可能对心肺移植中肺的保存有良好的作用。

Four studies were undertaken to evaluate major problems in heart or heart-lung transplantation.1. It was important for experimental orthotopic heart transplantation to avoid the hemolysis by appropriate blood transfusion and prevent the lung edema under blood priming-middle flow cardiopulmonary bypass. The end-systolic pressure/end-systolic volume ratio of donor hearts decreased immediately after the transplantation. There was no change in the conductivity and refractoriness of the transplanted heart during early postoperative period. We made our own practical manual about the technique of harvest, preservation and orthotopic transplantation of a donor heart and the perioperative care of a recipient.2. Electrophysiologic assessment of the transplanted canine heart disclosed that the prolongation of effective refractory period of the atrio-ventricular conduction system had significant sensitivity for cell infiltration in the conduction system. These results suggested the feasibility of electrophysiologic monitoring as a means for detecting acute rejection in the pre-necrotic stage in transplanted hearts.3. Pulmonary flow-resistance relationships in canine allograft single lung transplantation showed that the allografts, of which water content remained within twice the normal, could tolerate well the normal range of pulmonary blood flow. These results implied that single lung transplantation could be an effective treatment for pulmonary hypertension.4. The lungs after four hours preservation with a heart had better total compliance and lesser damage of air-blood-barrier in the artificial surfactant-treated group than in the unteated group. These facts suggested that the artificial surfactant supplement may provide a favorable effect on the lung preservation in heart-lung transplantation.