[Postoperative monitor of hemodynamics of orthotopic heart transplantation and treatment of its disorders].

OBJECTIVE: To study the postoperative hemodynamics after heart transplantation and treatment for disorders due to denervated transplanted hearts in order to improve the short term outcome of heart transplantation. METHODS: Forty one patients with endstage cardiopathy underwent orthotopic cardiac transplantation. The changes in the graft function were closely monitored during the postoperative period in order to maintain the stability of hemodynamics of the allografts. RESULTS: All recipients received vasoactive drug therapy and 6 recipients died of acute dysfunction of the right ventricle of the allograft during the postoperative period. The remaining patients survived well and led a life with rather good quality. CONCLUSION: The hemodynamic characteristics of a denervated grafted heart are unique. Close monitoring and good nursing care with rational administration of vasoactive drugs are the key measures for the prevention of acute dysfunction of the allograft in the early postoperative period.

[Experience in donor-recipient gender mismatching heart transplantation: analysis of seven female patients receiving male donor hearts].

OBJECTIVE: To summarize the experience in donor-recipient gender mismatching heart transplantation. METHODS: Seven female patients with end-stage cardiopathy aged 13 approximately 44, underwent orthotopic transplantation of hearts from male donors. Fine-tuning immunosuppressive protocols were adopted: Stanford classic therapy was applied on 3 cases and immunosupression induction therapy was applied on 4 cases. The clinical outcomes were observed for an average of 20 months (5 approximately 54 months). RESULTS: No acute reject reaction was found in all 7 cases within 3 months postoperatively. The earliest 2 patients died of refractory rejection 38 and 34 months postoperatively due to immunosuppressive withdrawal because of financial difficulty. The other 5 cases resumed their normal work and daily life. No allograft dysfunction, severe opportunistic infection episodes, and injury of liver and kidney functions were found in all cases. CONCLUSION: Fine-tuning immunosuppressive protocols improve the short-term and long-term clinical effects of donor-recipient gender mismatching heart transplantation.