Cardiovascular physiology in a case of heterotopic cardiac transplantation.

Successful heterotopic cardiac transplantation in a 24 year old man with end stage cardiomyopathy provided an opportunity to study cardiovascular physiology. The donor and native hearts, functioning independently in parallel, were studied by serial physical examination, electrocardiography, echocardiography, nuclear angiography and cardiac catheterization. Results indicated that the donor left heart assumed the predominant role in supplying systemic output, possibly contributing to decreasing function of the patient's own (native) heart. Analysis of serial nuclear angiograms revealed an initial postoperative ejection fraction of 52 and 21 percent in the donor and the native left ventricle, respectively; repeat studies 3 months postoperatively showed values of 50 and 9 percent, respectively, indicating significant deterioration in native left ventricular cardiac function. Observation of valve motion of the native heart showed major irregularities of the aortic valve in contrast to seemingly normal, regular mitral valve motion. These data rise interesting questions regarding interpretation of valve motion as an indicator of ventricular function.

Endomyocardial biopsy: its history, techniques and current indications.

Endomyocardial biopsy has found wide application as a diagnostic tool in the practice of cardiology and is of great clinical use in selected cardiac disorders. It is indispensable in the management of cardiac transplant recipients and has become increasingly valuable in the diagnosis of myocarditis and certain cardiomyopathies. Technical difficulties have been overcome, and the procedure is straightforward and of low risk in experienced hands. It is hoped that advances in endomyocardial biopsy will lead to a greater ability of physicians to diagnose and treat cardiac disease.