Persufflation (PSF; gaseous oxygen perfusion) is an organ preservation technique with a potential for use in donor heart preservation. Improved heart preservation with PSF may improve outcomes by maintaining cardiac tissue quality in the setting of longer cold ischemia times and possibly increasing the number of donor hearts available for allotransplant. Published data suggest that PSF is able to extend the cold storage times for porcine hearts up to 14 hours without compromising viability and function, and has been shown to resuscitate porcine hearts following donation after cardiac death. This review summarizes key published work on heart PSF, including prospective implications and future directions for PSF in heart transplantation. We emphasize the potential impact of extending preservation times and expanding donor selection criteria in heart allotransplant. Additionally, the key issues that need to be addressed before PSF were to become a widely utilized preservation strategy prior to clinical heart transplantation are summarized and discussed.

No description available.

With improved survival following cardiac transplantation, attention has focused upon the quality of that survival and some of the variables that may impact quality of life. The present study objectively measured subjective aspects of quality of life in order to discover its pre- and postoperative predictors. Results indicate that immunosuppression following heart transplantation creates a significant number of complications and symptoms for the recipient and is significantly related to elevated levels of psychological distress, particularly depression and anxiety, and decreased self-esteem. These findings emphasize the importance of careful symptom evaluation and targeting of distressed patients for psychological intervention in clinical settings and underscore the importance of continued medical research to improve immunosuppression therapy. Descriptive statistics reveal a rather mixed picture of postoperative quality of life which may result from the difficult clinical reality in which heart transplant patients often trade one set of preoperative cardiac symptoms for another set of postoperative symptoms related to immunosuppression therapy.

Thesis (M.S.)--University of Wisconsin--Madison, 1990. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 54-58).

The purpose of this study was to describe the presence of uncertainty experienced by heart transplant recipients at one and two year diagnostic follow-up evaluations. Twelve one year and eleven two year transplant recipients completed the Mishel Uncertainty in Illness Scale (MUIS), prior to and after cardiac catheterization. There was a decrease in uncertainty levels from pre to post-catheterization, for both one and two year recipients, however, findings were not significant. Recipients prior experience with catheterization and the interaction effects of the complete evaluation process or future health status may have affected the subject's uncertainty response. Two year transplant recipients demonstrated significantly higher uncertaintly levels, before and after cardiac catheterization, when compared to one year recipients. These findings lend initial and tentative support to the proposal that uncertainty increases with time post-transplant. The yearly follow-up evaluation may represent an episodic focusing for the transplant recipient on health status.

published_or_final_version / Surgery / Doctoral / Doctor of Philosophy

Background: Each year, thousands of patients around the world receive a new heart through heart transplant surgery. This is a lifesaving action and is most common among people with a heart disease that has led to a severe and non-treatable heart failure, for instance cardiomyopathy. But the process of receiving a new heart comes with challenges and the patients can experience emotional and physical difficulties. Aim: The aim of this study was to illuminate adult patients' experiences after heart transplantation. Method: A literature-based study was conducted and fourteen scientific qualitative articles were analyzed with a qualitative approach. Results: After analyzing the results, three main themes emerged; "To receive someone else's heart", "Learning how to live" and "To experience difficult emotions". Each main theme had three significant subthemes. The findings showed that a diversity of experiences arose among the patients after undergoing heart transplant surgery. They experienced gratitude, faith, concern, existential thoughts and sadness. They expressed support and the pursuit of gaining control in daily life as meaningful and essential. But they also had to handle limitations in their lives concerning the medical treatment, the continuous follow-ups and the diet restrictions. Conclusion: As a nurse it is fundamental to see the heart transplant patient as a unity and a unique person. Thus it is important to notice the patients' psychological difficulties that can arise after heart transplantation and not only observe the physical problems. Communicate with the patients in a motivating and caring way and try to understand their individual experiences of the situation in order to promote their health. In that way we can lay a valuable foundation for nursing.

INTRODUÇÃO: O significado clínico das vasculites, lesões isquêmicas, efeito Quilty e da presença de eosinófilos em biópsias endomiocardicas de receptores de transplante cardíaco com rejeições leves não foi ainda estabelecido. OBJETIVOS: Verificar se estes achados histológicos encontrados nas biópsias endomiocardicas (eosinófilos, vasculites, efeito Quilty e lesões isquêmicas) são capazes de predizer rejeição aguda do enxerto acompanhada ou não de grave comprometimento hemodinâmico e morte por rejeição aguda. MÉTODOS: Foram reavaliadas 939 biópsias endomiocardicas consecutivas classificadas como OR ou 1R pela de 2005 da Nomenclatura da Sociedade Internacional de Transplante de Coração e Pulmão e dividimos estas em dois grupos (1) Biópsias preditoras: aquelas que precederam rejeição aguda, rejeição aguda associada à grave comprometimento hemodinâmico ou morte e (2) Biópsias não preditoras aquelas que não precederam eventos clínicos. Comparamos a ocorrência dos seguintes achados histológicos: vasculites, lesões isquêmicas, efeito Quilty e eosinófilos por análise uni e multivariada entre os grupos. RESULTADOS: Após análise estatística verificou-se que a presença de vasculite intensa e de eosinófilos como maiores preditores tanto para rejeição aguda futura, apresentando respectivamente as seguintes razões de chance: 10,60 (IC95%: 3,62 31,06. p<0,001) e 6,26 (IC95%:3,16 12,43. p< 0,001) , quanto para rejeição aguda associada á grave comprometimento hemodinâmico, que para este desfecho clínico apresentaram respectivamente as seguintes razões de chance 7,52 (IC95%: 1,45-38,93. p=0,016) e 6,61 (IC95%: 2,38 18,31. p< 0,001), e também para morte em decorrência a rejeição aguda com as respectivas razões de chance: 11,20 (IC95%: 3,53 36,17. p < 0, 001) e 14,50 (IC95%: 2,19 36,17. p = 0,006). CONCLUSÕES: Vasculites intensas e eosinófilos em biópsias do miocárdio são os principais fatores preditores de rejeição aguda, rejeição aguda associada à grave comprometimento hemodinâmico e morte pós - transplante cardíaco / INTRODUCTION: The clinical meaning of vasculitis, ischemic lesions, Quilty effect and the presence of eosinophils in endomyocardial biopsies of transplant recipients with mild rejections have not been established yet. OBJECTIVES: Verify if these histological findings (eosinophils, vasculitis, Quilty effect and ischemic lesions), whose clinical meaning remains unknown so far, are able to predict acute rejection of the transplanted organ, accompanied or not by severe hemodynamic compromise and death due to acute rejection. METHODS: We reevaluated 939 consecutive endomyocardial biopsies classified as 0R or 1R, according to the nomenclature that the International Society for Heart and Lung Transplantation established in 2005. We divided these biopsies in 2 groups, as they follow: (1) Predictor biopsies, which are preceded by acute rejection, acute rejection associated to severe hemodynamic compromise or death and (2) Non-predictor biopsies that did not precede any clinical events. We compared the occurrence of the histological findings studied (eosinophils, vasculitis, Quilty effect and ischemic lesions) through univariate and multivariate analysis among the groups. RESULTS: After an appropriate statistical analysis, the result obtained was the presence of intense vasculitis and eosinophils as the greatest predictors of future acute rejection, presenting the respective odds ratio: 10,60 (IC95%: 3,62 31,06. p<0,001) and 6,26 (IC95%:3,16 12,43. p< 0,001), as well as acute rejection associated to severe hemodynamic compromise, which presented the respective odds ratio for this clinical outcome: 7,52 (IC95%: 1,45-38,93. p=0,016) and 6,61 (IC95%: 2,38 18,31. p< 0,001) and death due to acute rejection, presenting the respective odds ratio: 11,20 (IC95%: 3,53 36,17. p < 0, 001) and 14,50 (IC95%: 2,19 36,17. p = 0,006). CONCLUSIONS: Intense vasculitis and eosinophils in myocardial biopsies post-cardiac transplantation are the chief factors that can predict acute rejection, acute rejection associated to severe hemodynamic compromise or death

A. INTRODUCTION A.1. The sympathetic nervous system. A.1.1. General considerations and historical perspective. A.1.1.1. Historical perspective A.1.1.2. Reflex regulation of the autonomic nervous system A.1.1.3. Central control of the autonomic nervous system A.1.1.4. Sympathetic and parasympathetic components of the autonomic nervous system A.1.1.5. Organisation of the sympathetic nervous system A.1.1.6. Functions of the sympathetic nervous system A.1.1.7. Neurotransmitters of the sympathetic nervous system A.1.1.8. Neurotransmitter secretion at effectors organ synapse A.1.1.9. Adrenoreceptors A.1.2. Control mechanisms A.1.2.1. Aortic arch and carotid baroreceptors A.1.2.2. Low pressure baroreceptors A.1.2.3. Chemoreceptors A.1.2.4. Effects of exercise on sympathetic nervous system activation A.1.2.5. Effects of left ventricular dysfunction on sympathetic nervous system activation A.1.2.6. Effects of right ventricular dysfunction and heart transplantation on sympathetic nervous system activity A.2. Methodological considerations. A.2.1. Assessment of sympathetic activity in humans A.2.2. Circulating catecholamines A.2.3. Microneurography A.3. Ergospirometry A.3.1. Several aspects of physiology of exercise A.3.2. Principles of exercise testing A.3.3. Exercise ventilation A.4. Assessment of chemoreceptor regulation in humans A.4.1. Peripheral chemoreceptor inhibition A.4.2. Peripheral and central chemoreceptor activation A.5. Brief summary of still unresolved questions A.5.1. Pulmonary arterial hypertension A.5.2. Heart transplantation B. SYMPATHETIC CONTROL IN PULMONARY ARTERIAL HYPERTENSION B.1. Hypothesis tested B.2. Study populations B.2.1. Study investigating sympathetic activity in PAH patients B.2.2. Study investigating the effects of atrial septostomy on MSNA in PAH patients B.3. Material, methods and study protocols B.3.1. Particular measurements in the study investigating sympathetic activity in PAH patients B.3.2. Particular measurements in the study investigating effects of atrial septostomy on MSNA in PAH patients B.4. Sympathetic nervous activity in PAH and effects of disease severity B.5. Effects of chemoreflex activation B.6. Effects of atrial septostomy C. SYMPATHETIC CONTROL AFTER HEART TRANSPLANTATION C.1. Hypothesis tested C.2. Patient population C.3. Material and methods C.4. Effects of chemoreflex activation on sympathetic activity and blood pressure C.5. Effects of chemoreflex activation on exercise intolerance D. DISCUSSION D.1. Sympathetic nervous system activation in patients with pulmonary arterial hypertension D.2. Effects of atrial septostomy on sympathetic nervous system activation D.3. Chemoreceptors in heart transplant recipients D.3.1. Peripheral chemoreceptors deactivation D.3.2. Peripheral and central chemoreceptors sensitivity E. CONCLUSIONS F. REFERENCE LIST G. ANNEXES G.1. Publications G.1.1. Velez-Roa and Ciarka et al, Increased sympathetic nerve activity in pulmonary artery hypertension, Circulation. 2004 Sep 7;110(10):1308- 12. G.1.2. Ciarka et al, Atrial septostomy decreases sympathetic overactivity in pulmonary arterial hypertension, Chest. 2007 Jun;131(6):1831-7. G.1.3. Ciarka et al, Effects of peripheral chemoreceptors deactivation on sympathetic activity in heart transplant recipients. Hypertension. 2005 May;45(5):894-900. G.1.4. Ciarka et al, Increased peripheral chemoreceptors sensitivity and exercise ventilation in heart transplant recipients. Circulation. 2006 Jan 17;113(2):252-7. G.2. Annexe thesis title. G.3. Brief summary in French of described research

Bakgrund: Personer som blir föremål för hjärttransplantation är mycket sjuka och det finns ingen annan behandling att tillgå. När hjärttransplantationen är genomförd krävs livsstilsförändringar och livslång och kontinuerlig behandling av immunosuppressiva läkemedel. En transplantation är en svårbegriplig händelse som väcker mångskiftande känslor. Syfte: Beskriva vuxna personers upplevelser efter en hjärttransplantation. Metod: En allmän litteraturstudie genomfördes. Resultat: I resultatet framkom fyra subkategorier: Känslor om det transplanterade hjärtat och donatorn, det psykiska lidandet, andligt och socialt stöd och framtidstro. Därefter bildades huvudkategorin: Livet som den hjärttransplanterade. Diskussion: Livet efter en hjärttransplantation är en komplicerad situation. Det kan vara en svårighet att anpassa sig till det donerade hjärtat. Det är därför viktigt med en god vårdrelation för att stötta och inge positiva aspekter till upplevd hälsa, detta har diskuterats utifrån Antonovskys teori KASAM. Slutsats: En god kontakt inbjuder till frågor om problem och funderingar kring sin hälsa vilket leder till trygghet och ökad kunskap. / Background: A person who are subject to heart transplantation is very ill and there is no other treatment available. When the heart transplantation is made lifestyle changes and life-long and continuous treatment of immunosuppressive drugs requires. A transplant is an obscure event that brings diverse emotions. Aim: To describe adults’ experiences after a heart transplantation. Method: A literature review was conducted. Results: In the result four subcategories appared: Emotion on the transplanted heart and the donor, the psychological suffering, spiritual and social support and belief in the future. Subsequently formed the main category: Life as the heart transplant. Discussion: Life after a heart transplant is a complex situation. It can be a difficulty to adapt to the donated heart. It is therefore important, but good health care relationship to support and inspire positive aspects of perceived health, this has been discussed on the basis of Antonovsky theory of Sense of Coherence. Conclusion: A good contact to invite questions about their health problems leading to security and increased knowledge.