Gamma-chain T-cell receptor transcripts are clonally expanded in the coronary arteries of cardiac allografts from patients with chronic rejection.
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Chronic Disease↗
Biomedical subjects
V Jeevanandam
Publications and source records attributed to V Jeevanandam.
Electrophysiologic effects of intravenous aminophylline in heart transplant recipients with sinus node dysfunction.
BACKGROUND: Sinus node dysfunction has been reported to occur in up to 50% of orthotopic heart transplant recipients, and oral theophylline has been used in an attempt to limit the morbidity associated with this abnormality. The purpose of this study was to evaluate the electrophysiologic effects of methylxanthines on sinus node function. METHODS: Sinus node testing performed in 26 patients before and after the infusion of 6 mg/kg of aminophylline. Thirteen of these patients had abnormal sinus node function at baseline, and thirteen had normal sinus node function. Sinus node dysfunction was diagnosed by a rhythm other than sinus in five patients, a prolonged corrected sinus node recovery time in two patients, and the presence of a secondary pause in six patients. RESULTS: In patients with abnormal sinus node function a significant decrease was observed in the sinus node recovery time (-14% +/- 5%) and corrected sinus node recovery time (-33% +/- 25%) in response to aminophylline; however, neither parameter was normalized. A decrease in the sinus cycle length (-6% +/- 8%) was not statistically significant. In patients with normal sinus node function, a significant decrease was seen in both the sinus node recovery time (-9% +/- 7%) and sinus cycle length (-9% +/- 4%). The corrected sinus node recovery time decreased by 4% +/- 28% in patients with normal conditions but was not significant. Overall, aminophylline resolved the underlying sinus node abnormality in only one of thirteen patients with abnormal sinus node function. CONCLUSIONS: This study suggests that the use of theophylline in patients with marked sinus node dysfunction may not decrease their risks for subsequent bradycardic events.
Adult↗
Radiofrequency ablation of Wolff-Parkinson-White syndrome in a donor heart after orthotopic heart transplantation.
Orthotopic heart transplantation was performed in a 65-year-old man with a donor heart with Wolff-Parkinson-White Syndrome. An electrophysiologic study performed 7 days after transplantation showed a left-lateral accessory pathway that exhibited only anterograde conduction. Radiofrequency ablation of the bypass tract was successfully performed, and no evidence of recurrence was found at 12 months' follow-up. We suggest that potential donors with known electrophysiologic abnormalities that are amenable to catheter ablation techniques should be considered for orthotopic heart transplantation, thus broadening the potential donor pool.
Aged↗
Reversal of donor myocardial dysfunction by triiodothyronine replacement therapy.
Triiodothyronine deficiency after brain death can result in progressive deterioration of cardiac function in potential organ donors. We report on the use of triiodothyronine replacement in improving myocardial function, allowing the use of donor hearts that might have been considered unsuitable for transplantation. From July to September 1992, of 24 organ procurements and transplantations, six donors were receiving high doses of inotropes with elevated left-sided filling pressures. Donor characteristics were as follows: five were male donors and one was a female donor, with mean age 16.50 +/- 7.50 years (8 to 30 years), mean weight 49.17 +/- 13.64 kg (25 to 63 kg), average time from clinical brain death to procurement 94.50 +/- 73.53 hours (49 to 240 hours), and two donors had arrest periods of up to 10 minutes. Despite large inotrope infusions, echocardiograms showed depressed left ventricular function (mean ejection fraction 39.17 +/- 5.85) and hemodynamic instability was present with elevated ventricular filling pressures. Triiodothyronine replacement (maximal dose 0.6 microgram/kg) was initiated an average of 139.17 +/- 32.00 minutes (115 to 185 minutes) before procurement. At the time of procurement, ventricular filling pressures were lower, hemodynamic condition stabilized, and pressor requirements decreased. Hearts were preserved in University of Wisconsin solution with a mean ischemic time of 188.83 +/- 36.86 minutes (149 to 237 minutes).(ABSTRACT TRUNCATED AT 250 WORDS)
Adenosine↗
Postpartum multivessel coronary dissection.
A 29-year-old woman had an acute myocardial infarction 5 days after giving birth. Serial coronary angiography showed multiple progressive coronary artery dissections, which eventually involved both the right and left coronary trees. Persistent cardiogenic shock necessitated emergent orthotopic heart transplantation. Examination of the cardiectomy specimen confirmed the presence of multiple myocardial infarctions, coronary artery dissection, and fibromuscular dysplasia of the coronary arteries. Fibromuscular dysplasia combined with changes in the arterial ground substance and hormonal milieu attributable to pregnancy or parturition are proposed as possible causes of coronary artery dissection in this case.
Adult↗