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10

^itiber 1, Part 2

Abstracts 189

Jmy/Bsbnwy 1991

141

143

rtUfl-TERM RESULTS IN DIABETIC PATIENTS UNDERGOING JSrDIAC TRANSPLANTATION • a Munoz, MD, James L o n q u is t, MD, B ra n is la v oM ovancevic, MD, R .T . B aldw in, MD, S tu a rt 2 rd MD, J • M ich ael Duncan, MD, O.H. F r a z ie r , MD ?exas H eart I n s t i t u t e , H ouston, Texas

DETERMINANTS OF MAXIMAL RIGHT VENTRICULAR FUNCTION. Richard Page, Wolfgang Harringer, George T Hodakowski, J Luis Guerrero, Paul J LaRaia, W Gerald Austen, Gus J Vlahakes. Massachusetts Gen Hosp/Harvard Med School, Boston MA 0 2 1 1 4 Following heart transplantation, RV failure can occur. Previous studies suggested that the maximal pressure the RV can develop (RVP) is determined primarily by RV perfusion pressure. However, the interaction of the pericardium (P) and LV pressure (LVP) with coronary perfusion pressure in determining maximal RVP remains unclear. Maximal RVP was determined in 4 groups of dogs across a range of LVP. Group I: open P, intact right coronary artery (RCA); Group II: open P, RCA perfused at 100 torr; Group Ills closed P, intact RCA; Group IV: closed P, RCA perfused at 1 0 0 torr.

■ compared lo n g -te rm r e s u lt s in 37 d ia b e t ic atien ts (mean a g e ; 51.6 + 9 .1 y e a r s ; 29 male rid 8 fem ale) t o 358 n o n - d ia b e tic p a t ie n t s who U n d erw en t c a r d ia c tr a n s p la n t a t io n d u rin g th e neriod from November 1984 t o J u ly 1990. Mean follow-up was 36.1 months. No d if f e r e n c e was o b serv ed between th e number o f r e je c t io n s p er oatient (1 .3 v s . 1 .2 ) nor s u r v iv a l a t 1 y e a r (81% vs. 77%) o r 2 y e a rs (72% v s . 70%). The d ia b e t ic copulation d id , how ever, d em on strate an in c re a s e d humber o f t o t a l i n f e c t i o n s p e r p a t ie n t (2 .4 v s . 1.1). T w e n ty - fiv e o f 30 p a t ie n t s s u r v iv in g one year were in s u lin -d e p e n d e n t. T w elve o f th es e patients were p r e - o p e r a t iv e in s u lin -d e p e n d e n t d iab etics who r e q u ir e d 2.2 tim e s th e ir p reoperative in s u lin dose a t one y e a r and 2.0 times a t two y e a r s . T h ir te e n p a t ie n t s w ere non­ insulin dependent p r e o p e r a t iv e ly and r e q u ir e d a mean o f 29 u n its/ d a y a t one y e a r and 30 u n its/d a y at two y e a r s . Seven o f th e 30 p a t ie n t s (2 3 .3 %) su rvivin g one y e a r d e v e lo p e d c o ro n a ry a r t e r y disease compared to 21% in n o n -d ia b e tic s . Despite th e need f o r In c re a s e d in s u lin and a higher r a te o f in fe c tio n , d i a b e t i c p a t ie n t s demonstrate equ al lo n g -te rm s u r v iv a l. Our experience su p p orts th e f e a s i b i l i t y o f c a r d ia c tra n s p la n ta tio n in d i a b e t i c p a t ie n t s .

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T R A N S P L A N T E D P A T IE N T S : IT R A C O N A Z O L E A S A F IR S T CH O ICE THERAPY? A. Gamba, R. Fioccbi, P. Ferrazzi, F. Mamprin, A . Cassisi, G. Troise, L. Parenzan Cardiac Surgery Pulmonary patients

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These results m ight depends on the- lim ita tion s o f conventional Amphotericin B or surgical treatment. In this study w e report a 100% survival rate with com plete regression o f the disease in four cases o f pulmonary or disseminated aspergillosis fro m two to fiv e years since the onset o f the disease. This success was due to the introduction in therapy o f a new im idazole derivative, itraconazole, which is extremely effective against Aspergillus fumigatus. Since 1985 to September 1990, 156 pts underwent heart transplant in our department. Four o f these patients developed post-operative aspergillosis 28 to 300 days after surgical intervention. In three cases the onset o f the disease was in the lung, whereas in the last case the primary lesion was discovered in the brain. Itracon azole therapy was in itia ted im m ed ia tely after the diagnosis in three cases;

in the first patient an unsuccessful tentative

with Am photericin B was in itia lly perform ed. T w o patients had an single localization o f aspergillum in the lung; a third patient presented with three pulmonary lesions and

three bone metastasis, later on;

in

the last patient the aspergillum was localized in the brain and in the kidney. Seven to 21 months o f itraconazole therapy induced a complete regression are alive

RCA intact vs. perfused (solid vs. broken lines): N.S. P open vs closed (filled vs open symbols); P