S Simonsen — Page 10 | PubMed Health

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Left ventricular aneurysm and severe cardiac dysfunction: heart transplantation or aneurysm surgery?

We analyzed data from 26 patients with left ventricular aneurysm and severe congestive heart failure to evaluate our selection criteria for aneurysm surgery and heart transplantation. The operative results for patients who underwent aneurysm resection (group A, n = 14) were compared with those of patients who were accepted for heart transplantation (group B, n = 12). All patients were monitored and reinvestigated after surgery. Functional status and left ventricular angiographic and hemodynamic findings were significantly worse in group B than in group A, but with great overlap between the groups. The presence of mitral insufficiency or right ventricular dysfunction (or both), however, was important in our selection for transplantation. Two patients died after aneurysm surgery, whereas one died before heart transplantation. Functional status (p less than 0.004) and left ventricular ejection fraction (p less than 0.05) improved after aneurysm resection, whereas hemodynamic values remained unchanged. Symptoms were relieved (p less than 0.001), and, except for cardiac index, hemodynamic values were normalized in group B. We conclude that the combination of a left ventricular ejection fraction of less than 25%, mitral insufficiency, and right ventricular dysfunction favors heart transplantation in patients with left ventricular aneurysm and end-stage heart disease. The lack of donor organs and acceptable results of aneurysmectomy, however, justify conventional surgery even in high-risk patients.

Adult↗

PubMedDate not supplied

Increased plasma angiotensinogen in cardiac transplantation patients.

OBJECTIVES: Interleukin 6 (IL-6) stimulates the production of angiotensinogen (renin substrate, RS), an acute phase reactant and the precursor of the potent vasoconstrictor angiotensin II. This study assesses the effect of cardiac transplantation on plasma levels of angiotensinogen and interleukin 6. METHODS: Effects of cardiac transplantation on plasma levels of renin substrate and IL-6 were studied in twelve patients with NYHA IV end-stage heart failure. Renin substrate, IL-6, plasma renin activity, C-reactive protein and serum amyloid A were determined 1 day before cardiac transplantation, and 1 day, 1 week, 4 weeks and 12 weeks postoperatively. Renin substrate was measured by both direct and indirect radioimmunoassay. An indirect assay measures intact renin substrate only, capable of releasing angiotensin I, while a direct assay measures both intact renin substrate and des-angiotensin I-renin substrate, the residue of renin substrate after cleavage of angiotensin I. RESULTS: Plasma renin substrate and IL-6 increased significantly on day 1 as compared with preoperative levels. Plasma renin substrate increased (measured by direct and indirect assay) by 64 and 50%, respectively, IL-6 levels by 43%. Plasma IL-6 returned to preoperative (normal) levels by 4-12 weeks. Plasma renin substrate levels remained elevated for the follow-up period of 12 weeks. The direct assay always gave higher values than the indirect assay, presumably due to consumption of renin substrate by renin. Consequently, a negative correlation between plasma renin activity and renin substrate measured with indirect assay was observed. CONCLUSIONS: Our findings suggest that cardiac transplantation brings about an acute phase reaction, mediated partly by IL-6, with increased synthesis of acute phase proteins like renin substrate. This may result in increased angiotensin II levels. Considering the trophic effects of angiotensin II on vascular tissue, increased production of renin substrate may contribute to the development of proliferative cardiovascular changes in heart transplant recipients.

Adolescent↗