The prevalence of right ventricular failure after ~rthotopic heart transplantation, evaluated in 196 patients, was 11.7%, as assessed by the presence during the first postoperative month of right atrial pressure >.10 mmHg. Two deaths, related to refractory right ventncular failure, were observed within the first month, both in subjects with preoperative pulmonary arteriolar resistances > 5 Wood Units. The haemodynamic profile a(fter heart transplantation showed a significant decrease ~ < 0.01) and an early normalization of pulmonary artenal pressure, pulmonary wedge pressure and pulmonary arteriolar resistances, while right atrial pressure slowly decreased until the third month. In a long-term analysis of s~rv.i~al (death within 1 year) the probability of death was stgntftcantly related to the values of right atrial pressure and cardiac index during the first month after heart translantation. Otherwise, the presence of elevated values of n?ht atrial pressure did not show a significant correlation ~Ith the echocardiographic right ventricular end-diastolic b •ameter nor with the presence of right bundle branch lock. The careful selection of patients referred for the c~rdiac transplantation (mean value of pulmonary artelar resistances in the evaluated subjects was 2.5 ± 1.5 ood Units) improves the probability of avoiding the ap-peara~ce of severe right ventricular failure in the postoperative period in most cases. The best predictor of right ventricular failure remains to be clearly identified. ~eY.words: Right ventricular failure-Pulmonary hyperelnston -Pulmonary vascular resistances -Heart transp antation !he development of secondary pulmonary hypertension ~s .~ frequent finding in patients with advanced cardiac 0~\~r e referred for heart transplantation. The evaluation e degree of pulmonary hypertension and pulmonary --~t ;eti~S~S to:vascular resistances is a critical issue in defining the indication for orthotopic cardiac transplantation. Previous experience in transplantation of patients with high pulmonary resistances has resulted in donor right heart failure generally in the early postoperative period.It is still unclear which among the various preoperative haemodynamic parameters indicative of pulmonary hypertension is a good predictor of the clinical and haemodynamicevolution after cardiac transplantation.The purposes of this study were to verify the prevalence of right ventricular failure after cardiac transplantation, to characterize the potential predictors of right ventricular failure after cardiac transplantation, and to evaluate the short-term (1 and 3 months) and long-term (1 year) mortality after heart transplantation in relation to the haemodynamic parameters before and after the cardiac transplant. Between November 1985 and April 1991, 196 orthotopic cardiac transplants were performed at the IRCCS Policlinico S. Matteo of Pavia, according to the criteria of the clinical programme of heart transplantation. MethodsThe patients ranged from 9 to 67 years of age (mean age 43.2); 176 were males and 20 ...

We retrospectively analyzed 275 consecutive transplanted patients, dividing them into group A (128 patients) affected by ischemic cardiomyopathy and group B (147 patients) affected by dilated cardiomyopathy. The difference in demographic, clinical and hemodynamic preoperative and postoperative data between the groups was studied; group A patients presented at transplantation with a less compromised hemodynamic picture, requiring inotrope infusion and mechanical assistance less frequently. The influence of etiology on early postoperative complications was also analyzed: group A patients needed postoperative mechanical assistance, inotrope, infusion and prolonged mechanical ventilation more often, therefore requiring a longer stay in the intensive care unit (ICU). Hospital mortality was twice as high in group A. The older age of group A patients per se did not influence these results significantly. The long-term follow-up was then studied with particular attention to parenchymal functions, hemodynamics, coronary artery disease, metabolic and surgical complications, and survival. The complication rate was higher in group A, with more severe hypertension and higher cholesterol levels at 1 year, a higher prevalence of accelerated coronary artery disease (CAD) and a more frequent onset of insulin-dependent diabetes. Surgical and vascular complications were also more frequent. The final result was a better 5-year actuarial survival rate for group B patients. Donor and recipient ages at the time of transplant did not influence this result. We conclude that ischemic patients, even if they are transplanted in better condition and operated more electively, have a more critical early and long-term postoperative course and a worse survival rate. These findings are not explained by advanced age, but could be due to the impact of atherosclerosis and metabolic impairments associated with ischemic disease.

Cardiac papillary fibroelastoma (CPF) is a rare primary cardiac tumour. This tumour constitutes about 10-15% of all primary cardiac tumours. We report here a case of CPF of an anomalous mitral valve chorda.

Among 265 patients transplanted at our Institution, 7 underwent cardiac retransplantation. There were five emergency retransplantations, the indication being graft failure in one case and acute rejection in four cases. Two patients, retransplanted because of acute rejection, had a positive panel reactivity antibody and a negative donor crossmatch. In the rejection cases immunosuppression was enhanced by perioperative plasmapheresis and a postoperative 1-month course of cyclophosphamide. In two cases emergency retransplantations were successfully performed despite a highly positive prospective crossmatch. Two patients underwent elective retransplantations for chronic rejection 12 and 41 months, respectively, after the primary transplants. The overall early and late survival rates are 71% and 57%, respectively, with a mean follow-up of 48.5 months. The early and late mortality for elective retransplantation is zero. Our experience confirms both the high operative risk for emergency retransplantation and the excellent results for elective retransplantation. The use of plasmapheresis and cyclophosphamide allowed us to undertake retransplantation successfully in 2 cases with positive donor crossmatch. Both hyperimmunized patients in our series were retransplanted because of irreversible acute rejection despite a negative crossmatch with the primary donor. The meaning of negative crossmatch in patients with preformed cytotoxic antibodies is therefore questionable.