Clinical history and anatomic findings following the longest survival after cardiac transplantation

The authors report the case history of the first patient in the world to have survived 18 and a half years with a heart transplant. This survival was marked by several episodes of rejection during the early years and various other incidents. The pathology encountered was primarily iatrogenic: diffuse osteoporosis sometimes limited the patient's activity. Two skin cancers and a lung cancer were diagnosed and treated. The patient died from progressive respiratory failure with pulmonary hypertension and signs of right ventricular failure. Pathological examination revealed a subnormal myocardium with a certain amount of overloading of the coronary arteries, confirmed the lung cancer and pulmonary hypertension and, most importantly, revealed the presence of nodular regenerative hepatic cirrhosis responsible for ascites during the last few months of life and a renal adenocarcinoma. These last two lesions are observed in immunosuppressed patients. The authors pay tribute to this patient who led an active and devoted life in the service of others.     

羟甲基戊二酰辅酶A还原酶抑制剂的研究进展

目的：介绍ＨＭＧＣｏＡ 还原酶抑制剂类药的研究进展,为临床合理用药提供参考。方法：以国内外发表的论文为基础,经分析,归纳,从药理作用、体内过程、临床应用、副作用及产品发展概况等方面介绍洛伐他汀、普伐他汀、辛伐他汀、氟伐他汀及西伐他汀等药品。结果与结论：大量资料表明,ＨＭＧＣｏＡ 还原酶抑制剂是一类疗效显著、毒副作用少,耐受性好的理想降血脂药物,该类药的问世为治疗高胆固醇血症开辟了新途径。     

18 and one-half years' survival after cardiac graft. Clinical course and anatomical findings

Operated upon in November, 1968, the last survivor of heart transplant recipients in those times has died on May 11, 1987, having survived 18 years and 6 months. The active life of this patient, however, was marred by episodes of graft rejection during the first post-operative years and by various incidents. It was mainly the complications of the immunosuppressive treatment that hampered his activities (osteoporosis) and provoked his death. Post-mortem examination confirmed that the heart was in good condition, found an active bronchial epithelioma and revealed iatrogenic lesions, namely adenomas, adenocarcinoma of the kidney and "regenerative" nodular hyperplasia of the liver with portal hypertension. Such lesions are observed in patients under long-term treatment with immunosuppressants. A "sleep apnoea" syndrome might have accounted for the formation of pulmonary hypertension lesions. The authors wish to pay their respects to this man who devoted himself to the service of other men.     

A technique for annular plication to facilitate sliding plasty after extensive mitral valve posterior leaflet resection

The sliding leaflet technique has been used in mitral valve repair in conjunction with posterior leaflet quadrangular resection to avoid left ventricular outflow tract obstruction secondary to systolic anterior motion of the anterior leaflet of the mitral valve. On occasion, despite the use of the sliding leaflet technique, reattachment of the edges of the posterior leaflet after extensive resection can be challenging because of excessive tension. My colleagues and I present our technique to ensure reattachment of the posterior leaflet without tension after extensive resection.     

Sevoflurane alters right ventricular performance but not pulmonary vascular resistance in acutely instrumented anesthetized pigs

OBJECTIVE: Although the effects of halogenated agents on both normal and diseased left ventricles have been widely studied, the influence of these anesthetic agents on right ventricular (RV) performance remains less well characterized. This study was undertaken to examine the effects of 2 different concentrations of sevoflurane on RV function, and coronary and pulmonary hemodynamics in acutely instrumented anesthetized pigs. DESIGN: Prospective experimental study. SETTING: Laboratory of experimental research in a university teaching hospital. SUBJECTS: Anesthetized pigs. INTERVENTIONS: Regional RV function in 10 pigs was determined from pressure segment length loop analysis, global RV function from stroke work versus end-diastolic pressure relation, right coronary blood flow, and pulmonary vascular resistance (PVR), without and then with 2.6% (minimum alveolar concentration [MAC]) and 3.9 % (1.5 MAC) end-tidal sevoflurane concentrations. MAIN RESULTS: Sevoflurane preserved inflow systolic shortening and RV regional external work, but significantly depressed outflow systolic shortening (p < 0.05). Global RV stroke work was depressed to 72% +/- 12% and 61% +/- 10% of baseline value, respectively, with 1 and 1.5 MAC of sevoflurane (p < 0.05), but without alteration of PVR. Right coronary blood flow decreased dose dependently. CONCLUSIONS: Sevoflurane causes significant depression of global RV function associated with a qualitatively different effect on inflow and outflow tracts, without any modification of PVR.