This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by SCHROEDER, J. S. Articles by HARRISON, D. C. Search for Related Content PubMed PubMed Citation Articles by SCHROEDER, J. S. Articles by HARRISON, D. C.

(Circulation. 1969;40:155.)
© 1969 American Heart Association, Inc.

---

Acute Rejection Following Cardiac Transplantation

Phonocardiographic and Ultrasound Observations

JOHN S. SCHROEDER M.D.¹; RICHARD L. POPP M.D.¹; EDWARD B. STINSON M.D.¹; EUGENE DONG JR. M.D.¹; NORMAN E. SHUMWAY M.D.¹; DONALD C. HARRISON M.D.¹

¹ From the Cardiology and Cardiovascular Surgery Divisions, Stanford University School of Medicine, Palo Alto, California.

Nine patients have undergone cardiac transplantation at Stanford University Hospital. Three of these showed no clinical evidence of rejection and had essentially normal physical and phonocardiographic findings. There were eight distinct early rejection episodes in the other six patients. Early rejection was accompanied by decreasing QRS voltage, an early diastolic gallop, and frequently a rightward shift of the mean electrical axis of the heart. If not treated, this progressed to severe heart failure with a right ventricular heave, biventricular gallop, marked elevation of venous pressure with rapid y descent and severe dyspnea without orthopnea. Ultrasound measurements show increasing posterior wall thickness and overall heart diameter during the rejection episode. With aggressive therapy, all of these signs usually resolve rapidly, suggesting that dysfunction of the rejecting heart is secondary to the interstitial edema, vascular engorgement, and cellular infiltration, causing restriction of diastolic filling. These cardiovascular signs appear to aid detection of early cardiac rejection and allow treatment at an earlier stage of the rejection process.

Key Words: Heart sounds • Prednisone • Posterior wall thickness • Azathioprine • Antilymphocytic globulin • Immunosuppressive agents

This article has been cited by other articles:

				R. B. Whiting, J. Etzkorn, R. D. Wiens, J. G. Mudd, J. Codd, and V. L. Willman Serial Systolic Time Intervals Following Human Cardiac Transplant, and Subsequent Malignant Cardiac Compression Vascular and Endovascular Surgery, January 1, 1978; 12(1): 1 - 9. [PDF]

				Z. Q. Farooki, J. G. Henry, and E. W. Green Hemophilus Influenzae Pericarditis Associated with Meningitis: A Treatable Fatal Disease Clinical Pediatrics, July 1, 1974; 13(7): 609 - 610. [Abstract] [PDF]