1
|
You've Got Some Nerve (after Heart Transplantation). J Heart Lung Transplant 2022; 41:910-913. [DOI: 10.1016/j.healun.2022.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/04/2022] [Accepted: 02/05/2022] [Indexed: 11/21/2022] Open
|
2
|
Awad M, Czer LSC, Hou M, Golshani SS, Goltche M, De Robertis M, Kittleson M, Patel J, Azarbal B, Kransdorf E, Esmailian F, Trento A, Kobashigawa JA. Early Denervation and Later Reinnervation of the Heart Following Cardiac Transplantation: A Review. J Am Heart Assoc 2016; 5:JAHA.116.004070. [PMID: 27802930 PMCID: PMC5210323 DOI: 10.1161/jaha.116.004070] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Morcos Awad
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Lawrence S C Czer
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Margaret Hou
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sarah S Golshani
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael Goltche
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Michelle Kittleson
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jignesh Patel
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Babak Azarbal
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Evan Kransdorf
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Fardad Esmailian
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Alfredo Trento
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jon A Kobashigawa
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| |
Collapse
|
3
|
Cachemaille M, Olofsson M, Livio F, Pascale P, Zingg T, Boegli Y. Recurrent Asystole After Neostigmine in a Heart Transplant Recipient With End-Stage Renal Disease. J Cardiothorac Vasc Anesth 2016; 31:653-656. [PMID: 27663634 DOI: 10.1053/j.jvca.2016.06.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Matthieu Cachemaille
- Service d'Anesthésiologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - Magnus Olofsson
- Service d'Anesthésiologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Françoise Livio
- Division de Pharmacologie Clinique, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Patrizio Pascale
- Service de Cardiologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Tobias Zingg
- Service de Chirurgie Viscérale, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Yann Boegli
- Service d'Anesthésiologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| |
Collapse
|
4
|
Lee SR, Kang DY, Cho Y, Cho HJ, Lee HY, Choi EK, Oh S. Early Parasympathetic Reinnervation Is Not Related to Reconnection of Major Branches of the Vagus Nerve after Heart Transplantation. Korean Circ J 2016; 46:197-206. [PMID: 27014350 PMCID: PMC4805564 DOI: 10.4070/kcj.2016.46.2.197] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 09/03/2015] [Accepted: 10/01/2015] [Indexed: 12/30/2022] Open
Abstract
Background and Objectives Bicaval heart transplantation (HTx) may promote parasympathetic reinnervation. However, the prevalence and timing of reinnervation have not been fully investigated. Heart rate variability (HRV) and direct vagal stimulation were used to evaluate the presence of parasympathetic reinnervation after bicaval HTx. Subjects and Methods A total of 21 patients (time after HTx 0.52-4.41 years, mean 1.8±1.2 years) who received a bicaval HTx was enrolled. Reinnervation was evaluated using HRV values from 24-hour Holter recordings. A cross-sectional analysis of the HRV at 0.5-1, 1-2, and >2 years after HTx was performed. We also applied high-frequency electrical stimulation (16.7 Hz, 1 msec pulse width, ≤10 V) to the cardiac branches of the vagus nerve at the level of the superior vena cava in eight patients at 6 and 12 months after HTx. Results The degree of parasympathetic reinnervation corresponded to the time after HTx. The HRV analysis revealed that the root mean square of the successive differences between consecutive RR-intervals (RMSSD) and high-frequency power were significantly higher during the late period (>2 years) compared with the early period (0.5-1 year) after HTx. None of the eight patients who underwent direct vagal stimulation responded during the stimulation at 6 and 12 months, whereas incremental trends in HRV parameters were observed, which indicated that parasympathetic reinnervation began within 1 year after HTx. Conclusion Parasympathetic reinnervation seemed to begin in the early period (<1 year) after bicaval HTx. Reconnection of major branches of the vagus nerve may not be related to early reinnervation.
Collapse
Affiliation(s)
- So-Ryoung Lee
- Department of Internal Medicine, Division of Cardiology, Seoul National University Hospital, Seoul, Korea
| | - Do-Yoon Kang
- Department of Internal Medicine, Division of Cardiology, Seoul National University Hospital, Seoul, Korea
| | - Youngjin Cho
- Department of Internal Medicine, Division of Cardiology, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Division of Cardiology, Seoul National University Hospital, Seoul, Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Division of Cardiology, Seoul National University Hospital, Seoul, Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Division of Cardiology, Seoul National University Hospital, Seoul, Korea
| | - Seil Oh
- Department of Internal Medicine, Division of Cardiology, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
5
|
Tezcan B, Şaylan A, Bölükbaşı D, Koçulu R, Karadeniz Ü. Use of Sugammadex in a Heart Transplant Recipient: Review of the Unique Physiology of the Transplanted Heart. J Cardiothorac Vasc Anesth 2015; 30:462-5. [PMID: 26409923 DOI: 10.1053/j.jvca.2015.06.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Büşra Tezcan
- Yüksek İhtisas Education and Research Hospital, Ankara, Turkey.
| | - Alev Şaylan
- Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
| | - Demet Bölükbaşı
- Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
| | - Rabia Koçulu
- Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
| | - Ümit Karadeniz
- Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
| |
Collapse
|
6
|
Patil J, Stucki S, Nussberger J, Schaffner T, Gygax S, Bohlender J, Imboden H. Angiotensinergic and noradrenergic neurons in the rat and human heart. ACTA ACUST UNITED AC 2011; 167:31-41. [DOI: 10.1016/j.regpep.2010.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 10/28/2010] [Accepted: 11/25/2010] [Indexed: 11/29/2022]
|
7
|
Dalla Pozza R, Fuchs A, Bechtold S, Kozlik-Feldmann R, Daebritz S, Netz H. Short-term testing of heart rate variability in heart-transplanted children: equal to 24-h ECG recordings? Clin Transplant 2007; 20:438-42. [PMID: 16842518 DOI: 10.1111/j.1399-0012.2006.00502.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Heart rate variability (HRV) is reduced in adults and children after cardiac transplantation. Testing of HRV has been used to assess re-innervation of the cardiac graft; its reliability in ruling out acute graft rejection is still under investigation. This study used a short-term test on HRV in 23 heart and heart-lung transplanted children and adolescents and compared the results with 24-h ECG recordings. PATIENTS AND METHODS Twenty-three subjects (16.3+/-4.2 yr; 10 females) underwent a 10-min HRV test at two occasions and one 24-h ECG. HRV was calculated according to the time domain method (RR interval, standard deviation of RR interval) and the frequency domain method (total power, LF and HF for assessment of sympathovagal modulation of heart rate). RESULTS Correlation between the short-term tests and 24-h ECG was high with regard to the frequency domain analysis of HRV. Correlation was less pronounced in the time domain method. CONCLUSIONS In heart and heart-lung-transplanted children and adolescents, due to reduced overall HRV short-term testing may give as reliable data as 24-h ECG. Therefore, especially when power spectral analysis has to be performed as a longitudinal assessment of re-innervation of the cardiac graft, short-term testing may offer an easily applicable and non-invasive diagnostic tool. Further studies are warranted to investigate whether HRV testing may contribute to rule out acute graft rejection.
Collapse
Affiliation(s)
- R Dalla Pozza
- Department of Pediatric Cardiology [corrected] Ludwig-Maximilians University, Munich, Germany.
| | | | | | | | | | | |
Collapse
|
8
|
Pozza RD, Kleinmann A, Bechtold S, Fuchs A, Netz H. Reinnervation after heart transplantation in children: results of short-time heart rate variability testing. Pediatr Transplant 2006; 10:429-33. [PMID: 16712599 DOI: 10.1111/j.1399-3046.2006.00485.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To detect impairment in short-term heart rate variability (HRV) in children after heart and heart-lung transplantation (TX) as reported in adults. To assess vagal and sympathetic influence on the donor heart rate using frequency domain analysis of HRV. METHODS AND RESULTS Measurement of short-term HRV was performed in 17 patients (age 16.9+/-3.6, 6.1+/-3.7 yr after TX) and 12 healthy controls (age 14.8+/-3.0 yr). Testing consisted of a resting phase of 15 minutes followed by a tilt phase of 45 min. All HRV parameters were significantly impaired in transplanted patients: RR interval (RRI) 717.2+/-122.5 m/s (controls 827+/-139.7, p<0.05), standard deviation of RR interval (RRI-SD) 20.1+/-15.5 (89.9+/-38.4, p<0.001), RRI at tilt 607.9+/-79.7 (654.0+/-104.7, NS), RRI-SD at tilt 21.1+/-20.0 (60.4+/-31.4, p<0.001). Low-frequency (LF)/High-frequency (HF) ratio of HRV showed prominent sympathetic influence in TX-patients (3.38+/-5.60 vs. 1.18+/-0.86, NS) increasing during tilting (5.91+/-8.36 vs. 4.74+/-5.27, NS). In subgroup analysis, 4 yr after TX an increasing sympathetic control of heart rate was observed. CONCLUSION Short-term HRV is severely impaired in children after TX. If changes are observed, they are time-related and show increasing sympathetic influence starting from 4 yr after TX.
Collapse
Affiliation(s)
- Robert Dalla Pozza
- Department of Pediatric Cardiology, Ludwig Maximilians University, Munich, Germany.
| | | | | | | | | |
Collapse
|
9
|
Dalla Pozza R, Kleinmann A, Bechtold S, Netz H. Hypertension in Heart and Heart-Lung Transplanted Children: Does Impaired Baroreceptor Function Play a Role? Transplantation 2006; 81:71-5. [PMID: 16421479 DOI: 10.1097/01.tp.0000189927.70547.ef] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Baroreceptor control of beat-to-beat blood pressure in heart and heart-lung-transplanted children is impaired. Time-related trends of baroreceptor function recovery are studied and a possible correlation of baroreflex impairment and systolic hypertension may give evidence for supplemental medical treatment of hypertension. METHODS Seventeen patients (six female) 6.1 +/- 3.7 years (range 0.8-13.0 years) after heart (n = 14) and heart-lung (n = 3) transplantation (TX) were studied. Twelve healthy children and 10 children after liver and bone marrow TX taking cyclosporine A (CyA) served as control groups 1 and 2, respectively. Baroreceptor sensitivity (BRS) was calculated from noninvasive systolic beat-to-beat blood pressure (sBP) measurement during a resting phase and a tilt-table test. RESULTS BRS was significantly impaired in the study group at rest and during tilting; mean sBP was slightly elevated. Significant difference between patients on CyA and healthy controls was not observed. Discrete recovery of BRS occurred after 4 years postTX with decreased sBP (n = 12 pts, BRS 6.78 +/- 7.44 msec/mmHg, sBP 116.2 +/- 12.4 mmHg) when compared to a postTX time course of less than 4 years (n = 5 pts, BRS 4.02 +/- 4.21 msec/mmHg, sBP 122.0 +/- 6.7 mmHg, P = NS). CONCLUSION BRS is disturbed after TX in children; four years postTX, a minimal recovery of BRS and a discrete reduction of sBP seem to occur. Those patients with a persistent low BRS and elevated sBP may profit from pharmacological influence in sympathovagal imbalance.
Collapse
Affiliation(s)
- Robert Dalla Pozza
- Department of Pediatric Cardiology, Ludwig-Maximilians-University, Munich, Germany.
| | | | | | | |
Collapse
|
10
|
Tuinenburg AE, Van Gelder IC, Van Den Berg MP, Grandjean JG, Tieleman RG, Smit AJ, Huet RCG, Van Der Maaten JMAA, Volkers CP, Ebels T, Crijns HJGM. Sinus node function after cardiac surgery: is impairment specific for the maze procedure? Int J Cardiol 2004; 95:101-8. [PMID: 15159046 DOI: 10.1016/j.ijcard.2003.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2002] [Revised: 05/27/2003] [Accepted: 05/29/2003] [Indexed: 11/24/2022]
Abstract
BACKGROUND Maze surgery is a final solution for intractable atrial fibrillation (AF), but an adverse effect on postoperative sinus node function has been reported. Whether this also applies to other types of cardiac surgery is unclear. METHODS We assessed postoperative rhythm by means of repeated exercise tolerance testing, ambulatory electrocardiography, and non-invasive testing of autonomic function between 1 and 12 months after four types of cardiac surgery. Fourteen patients without structural cardiac disease and medically refractory AF underwent the maze III procedure, 11 patients with mitral valve disease and preoperative AF underwent valvar surgery combined with a (simplified) maze III procedure, and 8 patients with mitral valve disease in sinus rhythm (SR) underwent isolated valvar surgery. The control group consisted of eight patients with sinus rhythm who underwent coronary artery bypass surgery (CABG). RESULTS One month after surgery, the chronotropic response to exercise was depressed, mean heart rate was high, and heart rate variability (HRV) was low, especially after maze III, combined surgery, and isolated valvar surgery. Twelve months after surgery, moderate improvements were observed. After CABG, considerably fewer abnormalities were observed, and HRV parameters recovered to a large extent. Non-invasive testing of autonomic function indicated disturbed vagal modulation of heart rate in all three groups with atrial incision. CONCLUSION Thus, attenuation of HRV and vagal modulation of sinus node function are not confined to maze surgery but also apply to isolated mitral valve surgery. Atrial incision therefore appears to be crucial and presumably produces autonomic nervous damage followed by partial reinnervation. Nevertheless, cardiac surgery in general seems initially to impair sinus node function with partial recovery in the consecutive 12 months.
Collapse
Affiliation(s)
- Anton E Tuinenburg
- Department of Cardiology, Thoraxcenter, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Kim ED, Nath R, Kadmon D, Lipshultz LI, Miles BJ, Slawin KM, Tang HY, Wheeler T, Scardino PT. Bilateral nerve graft during radical retropubic prostatectomy: 1-year followup. J Urol 2001; 165:1950-6. [PMID: 11371887 DOI: 10.1097/00005392-200106000-00024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE With the interposition of a sural nerve graft to replace resected cavernous nerves at radical retropubic prostatectomy, we have previously reported the return of effective erectile function. We determine the efficacy of this procedure in a series of men with at least 1-year followup. MATERIALS AND METHODS A total of 12 potent men (mean age plus or minus standard deviation 57 +/- 6 years) with clinically localized prostate cancer underwent radical retropubic prostatectomy, with deliberate wide bilateral neurovascular bundle resection and placement of bilateral nerve grafts. A series of patient and partner erectile dysfunction questionnaires, and patient interviews were performed at 3, 6, 12 and 18 months postoperatively. Only results for those men with a followup of 12 months or greater (mean 16 +/- 4) are presented. A control group of 12 men who had undergone bilateral nerve resection but declined nerve graft placement, was also followed. RESULTS Of the 12 men 4 (33%) had spontaneous medically unassisted erections sufficient for sexual intercourse with vaginal penetration. An additional 5 (42%) men describe "40 to 60%" spontaneous erections, with fullness, no rigidity and not able to penetrate. Overall, 9 (75%) men had return of erectile activity. No demonstrable erections occurred before 5 months postoperatively. The greatest return of function was observed at 14 to 18 months after surgery. CONCLUSIONS This surgical technique has minimal morbidity and represents a significant advance in prostate cancer surgery in men requiring bilateral nerve resection. Our study clearly demonstrates recovery of erectile function in men who underwent bilateral nerve graft placement during radical retropubic prostatectomy when both cavernous nerves were deliberately resected.
Collapse
Affiliation(s)
- E D Kim
- Matsunaga-Conte Prostate Cancer Research Center, Division of Male Reproductive Medicine and Surgery, Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
KIM EDWARDD, NATH RAHUL, KADMON DOV, LIPSHULTZ LARRYI, MILES BRIANJ, SLAWIN KEVINM, TANG HSIAOYUAN, WHEELER THOMAS, SCARDINO PETERT. BILATERAL NERVE GRAFT DURING RADICAL RETROPUBIC PROSTATECTOMY: 1-YEAR FOLLOWUP. J Urol 2001. [DOI: 10.1016/s0022-5347(05)66248-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- EDWARD D. KIM
- From the Matsunaga-Conte Prostate Cancer Research Center, Division of Male Reproductive Medicine and Surgery, Scott Department of Urology and Departments of Pathology, Surgery, Neurosurgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, and Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, and Department of Surgery, Division of Urology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - RAHUL NATH
- From the Matsunaga-Conte Prostate Cancer Research Center, Division of Male Reproductive Medicine and Surgery, Scott Department of Urology and Departments of Pathology, Surgery, Neurosurgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, and Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, and Department of Surgery, Division of Urology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - DOV KADMON
- From the Matsunaga-Conte Prostate Cancer Research Center, Division of Male Reproductive Medicine and Surgery, Scott Department of Urology and Departments of Pathology, Surgery, Neurosurgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, and Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, and Department of Surgery, Division of Urology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - LARRY I. LIPSHULTZ
- From the Matsunaga-Conte Prostate Cancer Research Center, Division of Male Reproductive Medicine and Surgery, Scott Department of Urology and Departments of Pathology, Surgery, Neurosurgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, and Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, and Department of Surgery, Division of Urology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - BRIAN J. MILES
- From the Matsunaga-Conte Prostate Cancer Research Center, Division of Male Reproductive Medicine and Surgery, Scott Department of Urology and Departments of Pathology, Surgery, Neurosurgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, and Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, and Department of Surgery, Division of Urology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - KEVIN M. SLAWIN
- From the Matsunaga-Conte Prostate Cancer Research Center, Division of Male Reproductive Medicine and Surgery, Scott Department of Urology and Departments of Pathology, Surgery, Neurosurgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, and Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, and Department of Surgery, Division of Urology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - HSIAO-YUAN TANG
- From the Matsunaga-Conte Prostate Cancer Research Center, Division of Male Reproductive Medicine and Surgery, Scott Department of Urology and Departments of Pathology, Surgery, Neurosurgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, and Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, and Department of Surgery, Division of Urology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - THOMAS WHEELER
- From the Matsunaga-Conte Prostate Cancer Research Center, Division of Male Reproductive Medicine and Surgery, Scott Department of Urology and Departments of Pathology, Surgery, Neurosurgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, and Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, and Department of Surgery, Division of Urology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - PETER T. SCARDINO
- From the Matsunaga-Conte Prostate Cancer Research Center, Division of Male Reproductive Medicine and Surgery, Scott Department of Urology and Departments of Pathology, Surgery, Neurosurgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, and Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, and Department of Surgery, Division of Urology, University of Tennessee Medical Center, Knoxville, Tennessee
| |
Collapse
|
13
|
Bjerke RJ, Mangione MP. Asystole after intravenous neostigmine in a heart transplant recipient. Can J Anaesth 2001; 48:305-7. [PMID: 11305835 DOI: 10.1007/bf03019764] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To describe a heart transplant recipient who developed asystole after administration of neostigmine which suggests that surgical dennervation of the heart may not permanently prevent significant responses to anticholinesterases. CLINICAL FEATURES A 67-yr-old man, 11 yr post heart transplant underwent left upper lung lobectomy. He developed asystole after intravenous administration of 4 mg neostigmine with 0.8 mg glycopyrrolate for reversal of the muscle relaxant. He had no history of rate or rhythm abnormalities either prior to or subsequent to the event. CONCLUSION When administering anticholinesterase medications to heart transplant patients, despite surgical dennervation, one must be prepared for a possible profound cardiac response.
Collapse
Affiliation(s)
- R J Bjerke
- Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh School of Medicine, PA, USA.
| | | |
Collapse
|
14
|
Murphy DA, Thompson GW, Ardell JL, McCraty R, Stevenson RS, Sangalang VE, Cardinal R, Wilkinson M, Craig S, Smith FM, Kingma JG, Armour JA. The heart reinnervates after transplantation. Ann Thorac Surg 2000; 69:1769-81. [PMID: 10892922 DOI: 10.1016/s0003-4975(00)01240-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Whether cardiac reinnervation occurs after transplantation remains controversial. If reinnervation does occur, how sympathetic and parasympathetic efferent neurons do this remains unknown. METHODS Power spectral analysis of heart rate variability was assessed for 1 year after cardiac autotransplantation in 9 dogs. After induction of anesthesia 13 months after transplantation, cardiac and intrinsic cardiac neuronal responses elicited by both electrical stimulation of parasympathetic or sympathetic efferent neurons and systemic or local coronary artery administration of nicotine (5 microg/kg), angiotensin II (0.75 microg/kg), and tyramine (1.2 microg/kg) were studied. The transmembrane electrical properties of intrinsic cardiac neurons were studied in vitro. Ventricular tissue catecholamine content, alpha-tubulin expression, and beta-adrenergic receptor density and affinity were studied. The presence of axons crossing suture lines was sought histologically. RESULTS Nerves were identified crossing suture lines. Electrical or chemical (ie, nicotine or angiotensin II) activation of sympathetic efferent neurons enhanced cardiodynamics, as did tyramine. Stimulating vagal efferent preganglionic axons induced bradycardia in half of the dogs. Functional reinnervation did not correlate with specific power spectra derived from rate variability in the conscious state. Responding to nicotine and angiotensin II in situ, transplanted intrinsic cardiac neurons generated spontaneous activity. These neurons displayed nicotine-dependent synaptic inputs in vitro. Ventricular tissue had normal beta-adrenergic receptor affinity and density but reduced catecholamine and alpha-tubulin contents. CONCLUSIONS The intrinsic cardiac nervous system receives reduced input from extracardiac sympathetic efferent neurons after transplantation and inconsistent input from parasympathetic efferent preganglionic neurons. These heterogeneous neuronal inputs are not reflected in heart rate variability or ventricular beta-adrenergic receptor function. Transplanted angiotensin II-sensitive intrinsic cardiac neurons exert greater cardiac control than do nicotine-sensitive ones. The intrinsic cardiac nervous system remodels itself after cardiac transplantation, and this indicates that direct assessment of extracardiac and intrinsic cardiac neuronal behavior is required to fully understand cardiac control after transplantation.
Collapse
Affiliation(s)
- D A Murphy
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|