A. Ducharme et al., Characterization of the natural history of cervical heterotopic heart transplantation with echocardiography, J HEART LUN, 18(6), 1999, pp. 510-516
Background: Limitations of the dog model of orthotopic heart transplantatio
n to study rejection include the need for extracorporeal circulation and tr
ansfusions. Heterotopic cervical heart transplantation may improve on these
limitations. It is not known whether the natural history after heterotopic
transplant is similar to that after orthotopic grafting.
Methods: Twenty-one dogs underwent cervical heterotopic heart transplantati
on. Serial echocardiographic studies were performed 1 to 3 hours after surg
ery; at 24 hours, 48 hours later, and immediately before killing (5 to 7 da
ys).
Results: LV diastolic and systolic areas were elevated immediately,after tr
ansplantation (4.95 +/- 1.49 cm(2) and 3.36 +/- 1.18 cm(2) respectively) bu
t decreased at 24 hours (3.93 +/- 1.20 cm(2), p = 0.0003 and 2.44 +/- 0.96
cm(2), p = 0.16). Thereafter, a progressive increase in LV diastolic and sy
stolic areas was observed until sacrifice (5.53 +/- 2.20 cm(2) and 4.59 +/-
2.14 cm(2), p < 0.001 vs 24 hours). LV fractional area shortening (FAS) an
d fractional volume change were depressed immediately after transplantation
(28.2 +/- 12.8% and 40.4 +/- 12.3%, respectively), but increased at 24 hou
rs (35.7 +/- 10.0%, p = 0.11 and 50.3 +/- 4.0%, p = 0.02). FAS decreased at
48 hours to 19.6 +/- 11.1% (p = 0.01 vs 24 hours). The centractility index
es were markedly reduced before killing (FAS = 14.0 +/- 8.2% and LVEF = 18.
4 +/- 1.3%, p < 0.0005 vs 24 hours). The thickness of the interventricular
septum increased from 11.9 +/- 2.0 mm at baseline to 14.4 +/- 4.2 mm before
sacrifice (p = 0.007).
Conclusion: The evolution of dogs after heterotopic cervical heart transpla
nt is comparable to that after the more standard orthotopic graft. Consider
ing its multiple practical advantages including the easy echocardiographic
follow-up; heterotopic transplantation may become a very practical model to
use for the study of rejection after heart transplantation.