HEMODYNAMICS AFTER CARDIAC TRANSPLANTATIO N

Analysis of hemodynamic studies performed in 34 patients is presented. Survival over 1 year in this group of patients discharged alive after transplantation on triple component (cyclosporine A + methyl-predniso lone + azathioprine) immunosuppressive therapy was 99.2%. Hemodynamic monitoring in post-transplantation period for a mean time of 3 years a llowed to make the following conclusions. 1) There are no abnormalitie s in the pump function and contractility of the transplanted heart. 2) When function of the sinus node is normal heart rate of the graft is higher than that of the innervated heart. In sinus node disfunction im plantation of a temporary or permanent pacemaker is required for preve ntion of hemodynamic disturbances. DDD pacemaker is optimal for normal regulation of the cardiac output of the graft. 3) Increase of left ve ntricular afterload due to development of posttransplantation arterial hypertension requires prophylactic hypotensive therapy for prevention of hyperfunction, hypertrophy, dilatation and subsequent disfunction of the graft. 4) Secondary postcapillary pulmonary hypertension has fu nctional reversible character thus providing normal pre- and afterload for adequate functioning of the transplanted heart. Normalisation of the right ventricular pre- and afterload takes from several months to 1 year depending on the degree of preexisting disturbances of pulmonar y circulation, duration of graft ischemia, degree of right ventricular dilatation and tricuspid regurgitation. 5) Incidence of development o f reversible right ventricular failure correlates with the level of pr eexisting grafts right ventricular preload. 6) Derangements of the pum p function of the transplanted heart observed during moderate to sever e acute or chronic rejection with clinical signs of cardiac failure we re analogous to those characteristic for the heart of the recipient in pretransplantation period.