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At least 775 records · Page 43Linked to original sources
PubMed1992

Heart and lung preservation using a new solution; UCLA Formula.

Heart and lung preservation is a significant barrier in clinical heart and lung transplantation. In a previous study, we have shown that UCLA Formula, modified from cardioplegic solution, has a favorable effect on lung preservation. In this study, we evaluated the effect of the simultaneous flushing method using UCLA Formula alone on both heart and lung preservation. We conducted six experiments using 18 mongrel dogs, weighing 20-28 kg. In the donor animals, the heart and lungs were each flushed with 500 ml of cold UCLA Formula, using two catheters, one inserted into the ascending aorta and the other into the main pulmonary artery. After the heart and lung block was trimmed, orthotopic cardiac transplantation and single left lung transplantation were independently performed on different recipients following preservation for 4.3 h in the case of the heart and 7.5 h in the case of the lung. Thus, the function of the preserved organs was independently assessed using cardiac output and left ventricular end-diastolic pressure (LVEDP) with constant central venous pressure (CVP) in heart transplantation, and arterial gas analysis and the relationship between inspiratory pressure and expiratory tidal volume in lung transplantation. These measurements were performed before harvesting and 1 h and 4 h after transplantation. After heart transplantation cardiac output showed no significant deterioration. No significant differences in gas analysis and the pressure-volume curve were seen after lung transplantation. In conclusion, the simultaneous flushing method using the UCLA Formula may offer reliable preservation for both heart and lung in preparation for transplantation.

Animals↗
PubMed1997

Cardiopulmonary effects of high-impulse noise exposure.

In high-energy impulse noise environments, the biomechanical coupling process between the external forces and the pathophysiology of cardiopulmonary injury is not well understood. A 12-in-diameter compressed air-driven shock tube with reflector plate was used to induce three levels of pulmonary contusion injury in a large animal model. Twenty-one anesthetized sheep were exposed to the various levels of impulse noise generated by the shock tube, with six additional sheep serving as a control group. Pathologic evaluations, performed 3 hours after exposure, showed pulmonary contusion ranging from minor petechial changes on the surface of the lung parenchyma to diffuse ecchymoses affecting as much as 60% of the lung. The gross pathologic observations of injury produced by exposure to the impulse noise produced by the shock tube were similar to those reported for blunt impact trauma or exposure to chemical or grain-dust explosions. The extent of lung injury (lung injury index) was quantitatively assessed. A semilogarithmic relationship between the lung injury index and the measured peak pressure was demonstrated. A significant linear correlation was demonstrated between lung injury index and lung weight-to-body weight ratio. Significant cardiopulmonary changes were also observed as a result of exposure to high-impulse noise. Although in most cases the degree of change was related to the severity of the injury, significant cardiopulmonary function changes were also observed in the absence of significant grossly observable pulmonary injury. Cardiac injury was indicated by decreased cardiac output and hypotension at all levels of injury and might be the result of myocardial contusion or air emboli. Pulmonary injury was demonstrated by respiratory acidosis, increases in lung resistance, and decreases in lung compliance and lung volume. Arterial PO2 appeared to be the most sensitive parameter of injury and was decreased for all measurement intervals for all exposure groups.

Animals↗
PubMed2001

[The evaluation of efficacy and tolerability of salbutamol administered by nebulization in patients with stable severe bronchial asthma].

The aim of the study was the assessment of the effect of salbutamol in nebulization on ventilatory parameters and heart action in patients with stable severe well controlled bronchial asthma. The study was performed in 30 asthmatics (19 females and 11 men) with incomplete reversibility of airflow obstruction after salbutamol inhalation administered via MDI device. The mean age was 47 years, the duration of asthma--18 years. Mean FVC value was 2.46 L (66.6%), FEV1--1.76 L (56.8%), and MEF50--1.74 L/s (40.4% predicted). The study was performed according to the double-blind crossover method with placebo used. On the first day the reversibility test with 400 mg salbutamol was performed. On the two consecutive days salbutamol (Steri-Neb Salamol 2.5 mg) and placebo in nebulization were randomly administered. Ventilatory parameters were measured before and in 20, 40, 60, 120, 180 and 240 minutes after the nebulization. At the same time points the heart action was assessed by physical examination. The changes in FVC, FEV1 and MEF50 were expressed in absolute values and as a relative increase in relation to predictive value. The significant improvement of measured ventilatory parameters was observed as early as 20 minute after the nebulization. This increase in MEF50 lasted 2 hours, in FEV1--3 hours and in FVC 4 hours. The relative increase in MEF50 was significant higher than the remaining parameters. The significant increase in heart rate was noted after salbutamol nebulization.

Administration, Inhalation↗
PubMed2001

Laboratory confirmation of clinical heart allograft preservation variability.

BACKGROUND: Previously, we reported survival differences from the national heart transplant registry favoring centers that used intracellular organ preservation solutions. To eliminate center selection bias, we tested some of these solutions in a biventricular working rat heart model to determine their relative efficacy. METHODS: Using 103 Sprague-Dawley rat hearts perfused with modified Krebs-Henseleit buffer, both ventricles functioned with adjustable independent preload and afterload and their pressure-length loops generated load-insensitive measurements of cardiac performance. After 15 minutes of stable function, each heart sustained 180 minutes of cold (4 degrees C) ischemia after a 5-minute perfusion by University of Missouri (UMC), Plegisol, Collins, University of Wisconsin, Custodiol, or Roe solutions. Eighty-two hearts were reperfused and the remainder were used for ATP analyses. RESULTS: Although the extracellular solution Plegisol showed good recovery of traditional hemodynamic values, including developed pressure and cardiac output, intracellular solutions like Roe had superior preservation of load-insensitive indices such as preload recruitable stroke work: Roe (intracellular) 103%+/-13%; Custodiol (intracellular) 96%+/-9%; UW (intracellular) 69%+/-12%; Collins (intracellular) 68%+/-9%; Plegisol (extracellular) 68%+/-7%; and University of Missouri (extracellular) 56%+/-10% (p = 0.04). Furthermore, recovery with intracellular solutions tended to be gradual but more progressive after ischemia in contrast to an early plateau shown by extracellular (p < 0.001). Right ventricular recovery and ATP measurements were similar between groups. CONCLUSIONS: These data support the superiority of certain intracellular preservation solutions and provide evidence that optimal heart organ protection may be difficult to judge clinically using hemodynamic values routinely available to the heart transplant surgeon. Care should be taken to verify the performance of some solutions used in heart organ transplantation.

Analysis of Variance↗
PubMed2004

Cardiovascular regulation and hippocampal sclerosis.

PURPOSE: Cardiovascular dysregulation has been detected in patients with temporal lobe epilepsy (TLE) by using cardiovascular reflex tests and analysis of heart rate variability (HRV). The two methods have not previously been used in the same study to compare them in the assessment of cardioregulatory function. Magnetic resonance imaging (MRI) is considered the best method to reveal structural changes such as hippocampal sclerosis associated with TLE. It is not known whether these structural changes modify cardioregulatory function in patients with TLE. METHODS: Standard cardiovascular reflex tests and analysis of spectral and dynamic measures from 24-h electrocardiogram (ECG) recordings were performed for eight patients with and 31 patients without hippocampal sclerosis and for 72 control subjects. MRI also was performed in each patient to reveal hippocampal sclerosis. RESULTS: Various measures of cardiovascular reflexes and HRV were diminished in patients with TLE compared with the control subjects. No significant differences were found in the measures obtained from the cardiovascular reflex tests or analysis of HRV between those with and without hippocampal sclerosis, although a nonsignificant trend toward reduced values was seen among those with hippocampal sclerosis. The values of cardiovascular reflexes and spectral analysis of HRV correlated with each other. CONCLUSIONS: These results suggest that functional rather than structural changes related to TLE are involved mainly as a mechanism of altered cardioregulatory function. The cardiovascular reflex test and analysis of HRV both appear to be useful in studying cardioregulation in patients with TLE.

Adult↗
PubMed1980

Monitor-guided responses. Operability with safety is increased in patients with peripheral vascular diseases.

Poor cardiopulmonary reserve was demonstrated in a group of 75 elderly patients undergoing elective vascular reconstruction when cardiovascular hemodynamics were analyzed with the automated physiologic profile (APP) preoperatively. Only 25 patients (33.3%) had normal left ventricular function (LVF) and did not need any corrective therapy before surgery. Increment in preload was necessary in 20 patients (26.7%) to improve myocardial function; 30 patients (40%) revealed abnormal LVF and hence required pharmacologic modulation and preload adjustment, inotropic support, and afterload reduction to enhance the ventricular performance. Conventional methods of clinical evaluation did not reveal the degree of compromised ventricular function and potential high risk of surgical morbidity and mortality in many of these patients. The APP disclosed subtle and important physiologic aberrations indicating modification of anesthetic and operative procedures and precise modulation of physiologic factors. Optimization was achieved in all except two patients, and only one was denied the benefits of vascular reconstruction.

Aged↗
PubMed1982

Assessment of diagnostic value of dipyridamole testing in angina pectoris.

In order to assess the diagnostic value of dipyridamole (D) testing, we studied the responses of 34 patients with chest pain and 10 normal subjects. Blood pressure and 12-lead ECG were recorded during and after intravenous infusion of 0.6 mg/kg dipyridamole for 10 minutes. Coronary arteriography and maximal or symptom-limited exercise tests were performed in the 34 patients with chest pain. During infusion 13 patients presented ischemic ST changes and 5 with anginal pain only. The latter group had normal coronary arteries. Among the 13 patients with ischemic ST changes, 7 had at least two critical coronary stenoses and the remaining 6 had no coronary lesions. Dipyridamole tests showed poor sensitivity (44%) and specificity (39%) with respect to coronary arteriography. The relatively high number of positive responses in subjects with normal coronary arteries indicates that the coronary steal phenomenon is not the sole cause of "ischemic" response to the drug. Indirect indexes of myocardial oxygen consumption were higher in patients with a positive response to drug infusion than in those with a negative response; however the value of rate-pressure product at infusion end never reached that observed at ischemic threshold during exercise testing in the same patient. This suggests that neither can oxygen consumption increase be considered as entirely responsible for ischemic response to dipyridamole. In conclusion dipyridamole test cannot be proposed for predicting critical coronary stenoses.

Adult↗