Abstract
Cardiac transplantation has become an accepted procedure for the therapy of some patients with end-stage heart disease. Actuarial data show a major impact on long term survival as a result of two factors: the introduction routine surveillance endomyocardial biopsy for monitoring cardiac rejection and its reversal with medication, and the use of Cyclosporine for maintenance immunosuppression. The effect of improved monitoring with cardiac biopsy was to provide focused augmentation of immunosuppressive drugs to reverse the rejection episodes. Cyclosporine seems to moderate the rejection response but it has had several consequences of its own. In addition to recognized toxicities, Cyclosporine has apparently changed the rejection response in ways that make previous non-invasive methods of monitoring rejection invalid [1,2]. Monitoring of the electrocardiographic voltage or the echocardiographic signs of right ventricular dilation, increased ventricular wall thickness and reduced systolic function are not reliable in patients treated with Cyclosporine. Therefore, endomyocardial biopsy remains the standard for diagnosis and monitoring of rejection episodes.
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Popp, R.L., Valantine, H. (1993). Is ultrasound of clinical value in the management of heart transplant patients?. In: Hanrath, P., Uebis, R., Krebs, W. (eds) Cardiovascular Imaging by Ultrasound. Developments in Cardiovascular Medicine, vol 134. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-2490-4_6
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DOI: https://doi.org/10.1007/978-94-011-2490-4_6
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