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Biomedical subjects

H G Fieguth

Publications and source records attributed to H G Fieguth.

At least 73 records · Page 4Linked to original sources
PubMed1988

Distant heart procurement. Impacts of storage solution composition on cardiac performance following transplantation.

In distant heart procurement, optimal storage conditions remain to be defined, especially with respect to the electrolytic concentrations of storage solutions. Between December 1986 and April 1987, heart transplants were carried out in 18 patients. After cardioplegic arrest (St. Thomas), the hearts were randomly stored in either Euro-Collins' solution (ECS; n = 9) or Ringer's solution (RS; n = 9) at 4 degrees C. For the first 24 h postsurgery, atrial pressures (LAP, RAP), systemic (MAP) and pulmonary pressures (PAP), and cardiac output (CO) were monitored. In addition, catecholamine and nitroglycerin requirements as well as the type of cardiac rhythm were documented. There was no significant difference between the groups in terms of the period of graft ischemia (ECS, 162 +/- 28 min; RS, 141 +/- 47 min); the MAP, RAP, LAP, and CO were also similar in both groups. The total amount of epinephrine needed to maintain the MAP between 60 and 80 mm Hg was 10.5 mg/24 h +/- 4.1 mg in ECS compared with 19.9 mg/24 h +/- 12 mg in RS (P less than 0.05). Despite less inotropic support, the left cardiac work index was considerably higher in the ECS group (P less than 0.05). In the first few postoperative hours, 8/9 RS patients needed either atrial (n = 4) or ventricular pacing (n = 4) for a heart rate of 90-100 beats/min (bpm), whereas only three ECS patients required atrial pacing (P less than 0.05). All other ECS hearts showed a spontaneous sinus rhythm.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Results of orthotopic heart transplantation for ischaemic cardiomyopathy.

From July 1983 to May 1987, 172 orthotopic heart transplantations were performed in 165 patients. Of these, 46 recipients (39 male, 7 female), aged between 26 and 56 years (mean age 47), suffered from ischaemic cardiomyopathy. Postoperative immunosuppression consisted of a triple drug regimen of cyclosporine A, azathioprine and, in the last 31 patients, low-dose steroids. The actuarial survival in this group of patients at 1 year and at 2 years was 71.9%. There were five early deaths: three due to acute rejection and two from multiple-organ failure and sepsis. Of the eight late deaths, two could be attributed to acute cardiac rejection and four to bacterial infections. In two patients, sudden death occurred in the presence of accelerated graft atherosclerosis. Mild-to-moderate coronary artery lesions were seen in five other patients undergoing angiography one year after transplantation. Apart from the well-known postoperative risk factors in cardiac transplant recipients, accelerated graft atherosclerosis appears to be an additional hazard in the subgroup surgically treated for ischaemic cardiomyopathy.

Adult↗
PubMed1987

Heterotopic heart-unilateral left lung transplantation in dogs.

A technique is presented for transplantation of the heart and left lung in the canine model. Preservation of the recipient's heart and right lung allowed heterotopic en bloc transplantation of the donor organs, thus preserving the normal respiratory pattern and obviating the need for cardiopulmonary bypass. Four experiments were performed to develop the surgical technique. The mean survival of the remaining 10 dogs studied was 23 +/- 28 days (range 3 to 91 days). The transplanted heart and lung could be investigated as in orthotopic heart-lung transplantation; bronchoscopy with bronchoalveolar lavage and endobrachial biopsy as well as endomyocardial biopsy were performed by standard approaches. This model is suitable for physiological and immunological long-term observations of cardiopulmonary transplantation in dogs.

Animals↗
PubMed1987

Pneumocystis carinii pneumonia following heart transplantation.

Pneumocystis carinii pneumonia represents a rare complication that is associated with a high mortality following heart transplantation. The cases of two heart transplant recipients who developed Pneumocystis pneumonia within the first 3 postoperative months are reported. Both patients had severe clinical symptoms of the disease; the diagnosis was confirmed by bronchoalveolar lavage, and the patients were treated with a combination of trimethoprim and sulfamethoxazole. Both patients recovered and are well at the time of this report.

Adult↗
PubMed1987

[Heart transplantation--postoperative management].

Heart transplantation represents a widely accepted therapeutic modality for patients with end-stage myocardial failure. With increasing experience, 1-year survival rates of over 75% and 5-year survival rates of over 60% have been achieved, mainly due to patient selection, standardized surgical techniques as well as improved postoperative management. During early follow-up, particular attention should focus on diagnosis and treatment of graft rejection and infection, which require individualized immunosuppression, while in the later postoperative course coronary atherosclerosis, hypertension, chronic renal insufficiency and malignancy become more important as potential complications. The general principles in the management of these patients are discussed.

Adolescent↗
PubMed1986

Management of immediate graft failure after cardiac transplantation using cardiopulmonary bypass and intraaortic balloon-pumping followed by cardiac retransplantation.

A 37-year-old man underwent cardiac transplantation for diffuse coronary artery disease and malignant arrhythmias. During the harvesting of the donor heart slight distention of the left ventricle was present due to insufficiency of the aortic valve. After explantation of the graft, fusion of 2 cusps was found and a commissurotomy of the aortic valve was performed and the graft transplanted. Despite maximum inotropic support immediate graft failure and aortic insufficiency was present and discontinuation of cardiopulmonary bypass (CPB) was impossible. After replacement of the aortic valve using a bioprosthesis and implantation of an intraaortic balloon-pump, low cardiac output persisted and CPB had to be continued. After 11 hours of normothermic cardiopulmonary bypass and intraaortic balloon-pumping a second graft became available and was retransplanted successfully. The postoperative course was uneventful and the patient remains well 3 months after the operation.

Adult↗
PubMedDate not supplied

External stimuli in the form of vibratory massage after heart or lung transplantation.

Manual vibratory massage is part of the preventive physiotherapeutic activities performed in intensive care units. The vibratory massage can be performed manually or as electrovibratory massage. The manual massage is a fast rhythmical vibration performed by the arm and shoulder muscles of the masseur and transferred to the patient's thorax by the hand. The hand of the masseur has to achieve a tremor with a frequency of 8 to 11 tremors/s. The aim of the pilot study was to examine the influence of manual vibratory massage on the pulmonary function of postoperative patients who were receiving mechanical ventilation, with special interest being focused on pulmonary ventilation and perfusion and cerebral blood flow velocity. Manual vibratory massage was performed postoperatively in the intensive care unit on eight patients: three patients had undergone heart transplantation, three had undergone lung transplantation, and two had undergone coronary artery bypass grafting (mean age, 53.6+/-8 yr). With the aid of continuous monitoring, we examined the changes of the respiration parameters and the cerebral blood flow velocity (measured by transcranial Doppler sonography). The vibratory massage was performed with a frequency of 8 to 10 vibrations/s for 15 min, 7.5 min on each side of the thorax, starting from the lower costal arch and progressing to the upper thoracic aperture. For 10 min before, during, and 10 min after the massage, the parameters of peripheral oxygen saturation, central venous pressure, mean arterial pressure, heart rate, lung resistance and compliance, tidal volume, respiration rate, and cerebral blood flow velocity were recorded at 2-min intervals. Moreover, before and after vibratory massage, arterial blood gases were determined. In four of the eight patients, it was possible to determine pulmonary arterial pressure, pulmonary capillary wedge pressure, as well as pulmonary vascular resistance. During the vibratory massage, we could prove a significant increase of the mean tidal volume by 30% (P = 0.008). The percutaneous oxygen saturation significantly increased also, from 92 to 93.6% (P = 0.002). Central venous pressure significantly decreased by 11% (P = 0.04), and pulmonary vessel resistance was reduced by 18.3% (P = 0.001). The pulmonary resistance decreased from 10.5 to 9.2 H2O/l/s (P < 0.05) by the end of the observation period. Cerebral blood flow velocity showed no significant change. Vibratory massage seems to improve pulmonary mechanism and perfusion, thus, reducing ventilation perfusion mismatch and increasing oxygen saturation.

Cerebrovascular Circulation↗
PubMedDate not supplied

Improvement of currently used methods for lung preservation with prostacyclin and University of Wisconsin solution.

After 6 hours of cold ischemia the quality of lung preservation was assessed in a canine heart-lung transplant model comparing three clinically used methods for lung preservation: donor core cooling by means of extracorporeal circulation (group I); pulmonary artery flush perfusion with either Euro-Collins solution after prostacyclin application (group II); or University of Wisconsin solution after donor pretreatment with prostacyclin (group III). In all cases St. Thomas Hospital solution was used for myocardial protection. Heterotopic heart and orthotopic left lung allotransplantation was performed in three groups of six mongrel dogs each according to the method of lung preservation. After transplantation cardiorespiratory function was assessed at FiO2 of 0.4 for a maximum of 12 hours. After surgery, significantly improved oxygenation of the donor lung was observed in groups II and III, compared to group I (p less than 0.01). Between groups II and III, no significant differences were found in the oxygenation during the first 5 hours, but in the later postoperative course pO2 values decreased in group II although they remained stable on a higher level during the entire postoperative course in group III (p less than 0.05). University of Wisconsin solution for lung preservation in combination with prostacyclin donor pretreatment provides superior postoperative oxygenation of the transplanted lung compared to currently used clinical standards represented by donor core cooling and Euro-Collins flush perfusion.

Adenosine↗
PubMedDate not supplied

Donor heart-related variables and early mortality after heart transplantation.

Impaired donor heart function after heart transplantation results in the necessity for prolonged catecholamine and ventilatory support of the patient. Subsequently the risk of multiorgan impairment, infection, and rejection will be increased. In this retrospective analysis we tried to identify donor-related risk factors in patients who died early after transplantation. Of 174 patients undergoing heart transplantation from October 1985 through October 1988, 22 (12.6%) died early. Of the total, 39 cases were evaluated retrospectively for donor-related logistic and metabolic factors. All donors were analyzed with respect to the early mortality for age, weight, height, maximum dopamine concentration, thyroid hormone levels, and the duration from brain death until explantation and ischemia. Thirty patients were survivors (group A); nine patients died early (group B). By multiple regression analysis a significant influence (group A vs group B) of donor age, dopamine support, and ischemic time on early mortality could be demonstrated, whereas donor weight and height, hormone levels of triiodothyronine and thyroxine, and duration of brain death showed no correlation. From this limited experience we conclude that use of hearts from older donors with higher catecholamine support and longer ischemic times will result in an increased early mortality. In contrast, no influence of prolonged brain death times and metabolic factors could be demonstrated.

Adult↗