Design, efficiency and application of experimental methods in heart transplantation

Abstract:  Heart transplantation in children with end-stage heart disease or severe congenital heart defect with uncertain surgical palliation, like the hypoplastic left heart syndrome, has become an accepted form of therapy in certain selected Medical Centers. Increasing number of heart transplantation in children have resulted from increased survival attributable to the introduction of cyclosporine. Nevertheless, the diagnosis of rejection in infants and children remains controversial being a great challenge derived by the need for repetitive and routine heart biopsies. Taking in mind that a non-invasive electrophysiologic method could be considered a promising method for monitoring heart allograft rejection the present study was begun. A total of 306 heart transplantation was performed, 206 heterotopic on rats and 30 orthotopic on dogs. Non-invasive monitoring of heart rejection was made by electrophysiologic techniques using an epicardial lead implanted on the donor heart. R wave and slew-rate measurements were performed daily at 30', primero, segundo, tercero quinto and séptimo day postransplant. These measurements were later compared to histopathologic studies. R wave and slew-rate values of alogenic or rejecting hearts were found to decrease significantly as compared to singenic or non-rejecting heart along the days. This non-invasive electrophysiologic method may be considered a promising and suitable method for monitoring heart allograft rejection.