Critical Care of the Recipients of Heart and Heartlung Transplants - PowerPoint PPT Presentation

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Title:

Critical Care of the Recipients of Heart and Heartlung Transplants

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Effective donor organ preservation. Endomyocardial and transbronchial ... months following transplantation. Home spirometer and repeated TBB ... – PowerPoint PPT presentation

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Title: Critical Care of the Recipients of Heart and Heartlung Transplants


1
  • Critical Care of the Recipients of Heart and
    Heart-lung Transplants
  • ? ? ? ?
  • ? ? ? ??

2
Heart and Heart-lung Transplant (HLT)
  • An effective clinical treatment
  • Cyclosporine
  • Effective donor organ preservation
  • Endomyocardial and transbronchial
  • biopsy to monitor rejection.

3
Types of Disease Treated by Cardiac
Transplantation
  • Idiopathic cardiomyopathy (50)
  • Ischemic heart disease (45)
  • Miscellaneous

4
Diseases Treated by HLT
  • Cystic fibrosis (27)
  • Eisenmengers syndrome (26)
  • Primary pulmonary hypertension (15)
  • Miscellaneous

5
Immediate Postoperative Period
  • Coagulopathy
  • Mechanical ventilation
  • Hemodynamic condition
  • Multiorgan dysfunction

6
Rejection Versus Opportunistic Infection
  • Clinically, it is difficult to separate
    opportunistic infection from lung rejection.

7
Transbronchial Lung Biopsy (TBB)
  • Rejection, perivascular lymphocytic
  • infiltrate
  • At 3 months and then annually
  • Systemically sampling each of the lobes.

8
Early Detection of Pulmonary Complication with
Home Spirometry
  • Significantly diminished dynamic lung
  • volumes
  • 5 percent reduction on 2 consecutive days

9
Diagnosis of Infection
  • Sputum bacteriology
  • CMV (serologic study, viral culture,
  • histologic inclusion bodies
  • Pneumocystic carinii (trophozoite on
  • silver stain)
  • HSV pneumonia (diagnosed histologically)

10
  • Augmentation of the
  • immunosuppression
  • contributes to infection

11
Bronchiolitis Obliterans
  • Irreversible severe airway obstruction
  • Vascular etiology
  • Closely related to the incidence and severity of
  • rejection that occurs within the first 6 to
    12
  • months following transplantation
  • Home spirometer and repeated TBB
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