Comparison of clinical and morphologic cardiac findings in patients having cardiac transplantation for ischemic cardiomyopathy, idiopathic dilated cardiomyopathy, and dilated hypertrophic cardiomyopathy.

This article compares intergroup and intragroup clinical and morphologic findings in patients with ischemic cardiomyopathy (IC), idiopathic dilated cardiomyopathy (IDC), and dilated hypertrophic cardiomyopathy (HC) undergoing cardiac transplantation (CT). Few previous publications have described findings in native hearts explanted at the time of CT. The explanted heart in 92 patients having CT was examined in uniform manner with particular attention to the sizes of the ventricular cavities and the presence of and extent of ventricular scarring. Of the 92 hearts examined, 47 had IC, 35 had IDC, and 10 had dilated HC. Although considerable degrees of intragroup variation occurred, the mean degree of left ventricular dilatation was similar among the patients with IC, IDC, and dilated HC. All patients with IC had left ventricular free wall scarring more extensive than that involving the ventricular septum, but the intragroup variation in the amounts of scarring was considerable. Nine of the 10 patients with dilated HC also had ventricular wall scarring, but it was more extensive in the ventricular septum than in the left ventricular free wall and involvement of the right ventricular wall also was present. Eight (23%) of the 35 IDC patients also had grossly visible ventricular scars but they were small and only 1 of the 8 had coronary narrowing and that was not in the distribution of the scarring. Narrowing of 1 or more epicardial coronary arteries >75% in cross-sectional area by plaque was present in all 47 IC patients, in 8 of the 35 IDC patients (7 had no ventricular scars), and in none of the 10 dilated HC patients. Coronary angiography was the major clinical tool allowing separation of the IC, IDC, and HC patients. Coronary angiography did not detect narrowing in any of the 8 patients with IDC who were found to have coronary narrowing on anatomic study. Thus, among patients with IC, IDC, and dilated HC having CT, distinctive anatomic features allow separation of patients with IC, IDC, and dilated HC, but within each group considerable variation in left ventricular cavity size and extent of ventricular scarring occurs.

Cardiac transplantation in adults with small hearts.

Cardiac transplantation is performed in some adults having cardiac conditions causing considerable cardiac dysfunction in the absence of an increase in cardiac mass.

Stability of long-term renal function in heart transplant patients treated with induction therapy and low-dose cyclosporine.

Long-term renal function was evaluated in heart transplant recipients who were treated with antilymphocyte globulin induction therapy and low-dose cyclosporine therapy. Although an initial 16% drop in the glomerular filtration rate occurred, long-term follow-up revealed stability of renal function. Four-year patient survival was 77.6%. Use of induction therapy with low-dose cyclosporine may preserve renal function without compromising long-term patient survival.

Simultaneous heart and kidney transplantation: a report of three cases and review of the literature.

Three cases of combined heart and kidney transplantation are presented. All three patients suffered from end-stage kidney disease, one chronic glomerulonephritis, two diabetic nephropathy. Ages of the patients were 22, 30, and 39 years, respectively. Two of the patients had the diagnosis of dilated cardiomyopathy and the third had ischemic heart disease. Patient follow-up is from 6 to 30 months. None of the patients have had a heart rejection and only one has had a kidney rejection. Cardiac and renal function remain excellent in all three patients. Glomerular filtration rates range from 53 to 77 ml/min. These three cases are compared with other reported cases in the literature. Combined heart and kidney transplantation may be of benefit in selected persons.

Limb loss following Military Anti-Schock Trousers (MAST) application.

External counterpressure is a safe and effective method to treat shock and restore central circulation. Experience with the short-term use of MAST has been favorable. If external counterpressure is maintained for extended periods, however, altered peripheral hemodynamics may result in permanent damage. The development of compartment syndrome requiring amputation is reported in two patients with associated leg fractures. This unfortunate experience suggests that the sustained use of MAST in patients with shock and comminuted lower extremity fractures may jeopardize limb survival.