Heart orthotopic

Orthotopic cardiac transplantation is the best therapeutic option for patients with chronic irreversible New York Heart Association Class IV HF, with a 10-year survival of approximately 50% in well-selected patients. 

Goenen M, Baele P, Lintermans J, Lecomte C, Col J, Ponlot R, Schoevardts JC, Chalant C. Orthotopic heart transplantation eleven years after left pneumonectomy. J Heart Transplant 1988 7(4) 309-11. 

Heart transplantation is usually an orthotopic procedure. Leaving most of the atria and septum of the recipient, the patient is placed on cardiopulmonary bypass. The donor heart is implanted by anastamosis of the left atrium to the residual left atrial wall and joining the right atrial wall and septum. The main pulmonary artery is connected to the ascending aorta."... 

Breisbiatt WM, Schulman DS, Stein K, Wolfe O, Whiteside T, Kormos R, Hardesty RL. Hemodynamic response to OKT3 in orthotopic heart transplant recipients evidence for reversible myocardial dysfunction. J Heart Lung Transplant 1991 10(3) 359-365. 

Murali, S., Kormos, R. L., Uretsky, B. F., et al. (1993). Preoperative pulmonary hemodynamics and early mortality after orthotopic cardiac transplantation The Pittsburgh experience. Am. Heart J. 126, 896-904. 

Cardiovascular A 50-year-old recipient of an orthotopic heart transplant died after acute allograft failure and hepatitis C viral infection death was attributed to cardio-toxicity from peginterferon alfa-2b [8" ]. 

The dynamic display of motion and perfusion is a new apphcation, which is enabled by the continuous or repeat acquisition of the target volume without table feed. The 16-cm detector width allows coverage of several organs including the pancreas, orthotopically located kidneys, the neck, the brain, and above all, the heart. When devising scan protocols for dynamic imaging, great care must be taken to minimize radiation exposure. 

Cardiac transplantation is the ultimate therapeutic option in end-stage CHF. Orthotopic cardiac transplantation is the surgical technique of choice, whereas heterotopic cardiac transplantation is performed primarily when there is high resistance in the pulmonary circulation of the recipient (and a heart-lung transplantation is impossible), the donor heart is too small, or in selected cases with acute but potentially reversible heart failure. In orthotopic transplantation the donor heart is joined to the recipients atria, aorta, and pulmonary artery. In heterotopic transplantation, the donor heart is implanted into the right thoracic cavity and anastomosed with the recipient s heart in a complex maimer in such a way that the donor heart takes over most of left ventricular output, while the recipient s heart continues to ensure right ventricular output. 

Reversible severe left ventricular systolic dysfunction with apical ballooning has abo been reported during dobutamine stress echocardiography [45, 46, 47, 48, 49, 50, 51, 52, 53, 54 ] and abo in one case after recovery from stress echocardiography [55 ]. In one case it occurred in a patient with previous orthotopic heart transplantation [56 ]. In another case it occurred in a patient who had had a subarachnoid haemorrhage [57 ], in which sympathetic nervous system activity b increased and in which acute myocardial infarction can abo occur. 

Gastwirth VG, Yang HS, Steidley DE, Scott RL, Chandrasekaran K. Dobutamine stress-induced cardiomyopathyin an orthotopic heart transplant patient. J Heart Lung Transplant 2009 28(9) 968-70. 

Additionally an elevated fixed pulmonary hypertension with a pulmonary vascular resistance of more than 6 Wood units is a contraindication for orthotopic heart transplantation. 

The total artificial heart (TAH) is designed for orthotopic heart replacement, and is thus capable of replacing the function of the entire heart. The artificial pumps are implanted orthotopically after the patient s diseased native heart has been removed. Currently there are only pulsatile designs available (CardioWest TAH, AbioCor IRH, Penn State TAH). A total artificial heart is indicated in patients with severe aortic valve insufficiency, intractable ventricular arrhythmias, an acquired ventricular septal defect, or irreversible biventricular failure requiring a high pump output (Renlund 2004). 

Antretter H, Poelzl G, Margreiter J et al (2002b) Successful transfer of a cardiac allograft from a heterotopic to an orthotopic position 16 years after heart transplantation. Transplantation 74 540-543... 

Derumeaux G, Habib G, Schleifer DM et al (1995) Standard orthotopic heart transplantation versus total orthotopic heart transplantation. A transesophageal echocardiography study of the incidence of left atrial thrombosis. Circulation 9211 196-201... 

Dreyfus G, Jebara V, Mihaileanu S et al (1991) Total orthotopic heart transplantation an alternative to standard technique. Ann Thorac Surg 52 1181-1184... 

Melton IC, Gilligan DM, Wood M A et al (1999) Optimal cardiac pacing after heart transplantation. PACE 22 1510-1527 Meyer SR, Modry DL, Bainey K et al (2005) Declining need for permanent pacemaker insertion with the bicaval technique of orthotopic heart transplantation. Can J Cardiol 21 159-163... 

Fig 2.2.2. Immediate post-surgical phases - stroke. A 55-year-old woman 14 days status post orthotopic heart transplant for constrictive/restrictive cardiomyopathy developed an acute embolic occlusion of the right middle cerebral artery trunk. Head CT demonstrated a large infarct in that right middle cerebral artery distribution with compression of the ventricles and some midline shift... 

Fig 2.2.8a, b. Pulmonary and extrapulmonary nocardiosis. A 57-year old man, 7 years status post orthotopic heart transplant for ischemic cardiomyopathy, developed pain in his right axilla with a palpable lump, a, b Chest CT demonstrated a large abscess in the right axilla, as well as many, bilateral, small pulmonary nodules and one larger mass on the right. The right axillary abscess was aspirated and cultures of the aspirate and of sputum grew Nocardia nova... 

Knosalla C, Weng Y, Warnecke H et al (1996) Mycotic aortic aneurysms after orthotopic heart transplantation. J Heart Lung Transplant 15 827-839 Kohashigawa JA, Kirklin JK, Naftel DC et al (1993) The Transplant Cardiologists Research Database Group pretransplantation risk factors for acute rejection after heart transplantation - a multi-institutional study. J Heart Lung Transplant 12 355-366... 

Levin T, Suh B, Beltramo D, Samuel R (2004) Aspergillus mediastinitis following orthotopic heart transplantation case report and review of the literature. Transplant Infectious Disease 6 129-131... 

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