RESUMO
In the last 10 years, lung transplantation has become an increasingly common procedure for patients with end-stage respiratory disease. Although long-term survival can be achieved, there is still significant morbidity within the first year. Early postoperative problems that may be anticipated include respiratory insufficiency, airway anastomotic problems, hemorrhage, infection, and episodes of acute rejection. These problems and others make the immediate perioperative period particularly challenging. With aggressive management, however, the probability of a successful outcome can be enhanced.
Assuntos
Cuidados Críticos/métodos , Transplante de Pulmão , Rejeição de Enxerto/prevenção & controle , Rejeição de Enxerto/terapia , Humanos , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/terapia , Infecção da Ferida Cirúrgica/prevenção & controle , Resultado do TratamentoRESUMO
In animal models using left ventricular assist systems over long time periods, myocardial cellular atrophy has been reported, raising concern that prolonged clinical use of such systems might lead to deterioration in left ventricular function. At the University of Pittsburgh, long-term clinical use of the Novacor (Baxter Healthcare Corp., Novacor Div., Oakland, Calif.) left ventricular support system for patients awaiting heart transplants has allowed study of the effects of long-term mechanical support on human subjects. This study determined that cardiac myocyte dimension is initially greater in patients with end-stage cardiac disease who require support rather than in patients with the same disease who do not require such support. Although myocyte dimension does decrease within a few days of the inception of support, this decrease merely brings cell size closer to the values usual in patients with chronic end-stage cardiac disease, and no further shrinkage is observed. Thus the Novacor left ventricular assist system does not appear associated with left ventricular atrophy, and its long-term use may not be detrimental to left ventricular function.
Assuntos
Coração Auxiliar , Miocárdio/patologia , Cardiomiopatias/patologia , Cardiomiopatias/terapia , Doença das Coronárias/patologia , Doença das Coronárias/terapia , Transplante de Coração , Humanos , Pessoa de Meia-Idade , Fatores de TempoRESUMO
Transient left ventricular dysfunction is commonly described in association with cardiopulmonary bypass (CPB). We evaluated changes in right ventricular (RV) function after elective cardiac surgery in 24 patients with normal preoperative cardiac function. In all, irrespective of distribution of coronary artery disease or use of pharmacologic support, a transient depression of RV systolic function with respect to both preinduction and initial postoperative (Postop) values occurred 262 +/- 116 min post-CPB as represented by a decrease in RV stroke volume index (25.0 +/- 1.7 vs. 33.4 +/- 1.9 ml/m2 Postop) and RV ejection fraction (31.0 +/- 2.2 vs. 45.6 +/- 2.5% Postop), and an increase in RV end-systolic and end-diastolic volume indices. This depression responded readily to pharmacologic therapy within 2 h, resolved within 24 h, and had no adverse consequences in these otherwise healthy patients. Further studies are needed to identify the cause of this phenomenon and its importance in patients with preexisting cardiac dysfunction.