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

开展了四项研究，以评估心脏或心肺移植的主要问题1。在预充血-中流体外循环条件下，合理输血，避免溶血，防止肺水肿，对实验性原位心脏移植具有重要意义。供心移植后即刻收缩末压/收缩末期容量比值下降。术后早期移植心脏的电导率和不应性无明显变化。我们制作了自己的实用手册，介绍了供体心脏的收获、保存和原位移植的技术，以及受者的围手术期护理。对移植犬心脏的电生理检测表明，房室传导系统有效不应期的延长对传导系统的细胞浸润具有明显的敏感性。这些结果提示电生理监测作为检测移植心脏坏死前期急性排斥反应的一种手段是可行的。犬同种异体单肺移植的肺血流-阻力关系表明，水含量维持在正常范围2倍以内的同种异体肺能较好地耐受正常范围的肺血流。提示单肺移植可能是治疗肺动脉高压的一种有效方法。人工肺表面活性物质处理组心脏保存4h后肺组织的总顺应性好于未处理组，气血屏障损伤轻于未处理组。提示人工肺表面活性物质在心肺联合移植中可能具有良好的肺保存效果。

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.