Cardiac allograft vasculopathy (CAV) remains to be one of the most serious complications after heart trans- plantation (HTx) and a main cause of death in patients survived the fi rst year after transplantation. Pregnancy- associated plasma protein A (PAPP-A), a potentially proatherosclerotic zinc binding metalloproteinase, has been shown to be elevated in ischemic heart disease patients and heart transplant recipient. The aim of the study was to evaluate the relationship between РАРР -A plasma levels and the extent of coronary lesions in heart transplant recipients. The study included 37 heart transplant recipients. CAV was diagnosed in 23 recipients. Our results showed that PAPP-A plasma levels were higher in recipients with CAV, did not correlate with the duration of time after HTx but were associated with the extent of coronary lesion.

One of the most essential autoimmunity risk factors for development of CAD are increasing level of anticardiolipin antibodies and homocystein. This report presents retrospective analyses of 39 heart transplant recipients with maximal follow up over 16 years. Our results showed that hyperhomocystenemia and high levels of anticardiolipin antibodies play great value in development of CAD. Thus relative risks for development of CAD in presence both high levels of anticardiolipin antibodies and homocysteine are higher, than in traditional nonimmune risk factors.

The study has shown that early diagnosis of the type and degree of immune disturbances in preparation for the operation and the fi rst signs of multiorgan failure and septic complications in the postoperative period in cardiac surgery patients were the rationale for the earlier substitution immunocorrection by immunomodulators of cytokine nature and intravenous immunoglobulin. It allowed increasing the ef fi ciency of the treatment of postoperative complications and lower mortality after operations with arti fi cial and assist circulation.

The article presents the comparative analysis of two schemes of prevention of infectious complications after cardio-surgery interventions in conditions of artificial blood circulation. The higher clinical effectiveness and economic practicability ща shorter course of antibiotic prevention is demonstrated.

Cytomegalovirus infection may be associated with the development of acute cellular rejection - the most frequent and serious complication after heart transplantation, limiting long-term survival of recipients. Biomarkers of inflammation and thrombosis, one of which is the product of platelet activation - a soluble CD40 ligand (sCD40L), also play an important role in the immunopathology of acute rejection.The aim of the study was to assess the risk of cardiovascular complications after heart transplantation under the combined effect of two factors - sCD40L and cytomegalovirus infection. We examined 64 heart recipients in the period of 12 years after heart transplantation. It was revealed that with the presence of elevated levels of sCD40L in combination with cytomegalovirus infection, risk of acute cellular rejection is higher. In recipients with low levels of sCD40L and without cytomegalovirus infection survival rate is significantly higher than in recipients with the presence of one or both of the studied risk factors.

Soluble form of CD40L is platelet activating factor, which is a marker of inflammation and thrombosis. Elevated levels of sCD40L before the heart transplantation are associated with the risk of early development of cardiovascular complications.The study included 54 patients who had received heart transplants. All recipients received a triple heart immunosuppressive therapy, including methylprednisolone, mycophenolate mofetil and cyclosporine A (20 recipients) or methylprednisolone, mycophenolate mofetil and tacrolimus (34 recipients). Patients were not differed by age, gender, etiology of heart failure before heart transplantation (p > 0,05). In the first group of transplant recipients, the relative risk of cardiovascular events with high sCD40L levels before transplantation was 3 2 (95% CI 1,4; 12,0). In the second group of recipients, respectively, 2.69 (95% CI 1,1; 8,5). SCD40L level after heart transplantation was significantly higher for patients receiving cyclosporine (P < 0.05).Increasing concentrations of sCD40L are associated with a higher incidence of cardiovascular complications.

Biomarkers of endogenous tissue destruction (PAPP-A), neoangiogenesis (PlGF) and thrombosis (sCD40L) may be significant risk factors for cardiovascular complications development in patients with ischemic heart disease and recipients after heart transplantation (HTx). The study was aimed to determine the role of PAPP-A, sCD40L, and PlGF in development of cardiovascular complication with graft failure in heart transplant recipients using a multivariate analysis.

The differentiation of the cases of the right ventricular failure in transplanted heart should be complex and challenging. The 28-year old man with dilated cardiomyopathy underwent orthotopic heart transplantation. After transplantation developed right ventricular failure. The biopsy (n = 5) didn’t reveal any signs of myocardial rejection. There were noted some signs of inflammation in lateral right ventricular wall only by gated SPECT. The right ventricular failure increased and 6 months later there was successfully performed the heart retransplantation on the patient. The virusological study revealed the Epstein–Barr virus in myocardium. The explanted heart research excluded limphoproliferative disease by immunogystochemical tests. The final diagnosis is myocarditis.

Cardiac allograft vasculopathy (CAV) remains to be one of the most serious complications after heart transplantation (HTx) and a main cause of death in patients survived the first year after transplantation. Pregnancy-associated plasma protein A (PAPP-A), a potentially proatherosclerotic zinc binding metalloproteinase, has been shown to be elevated in ischemic heart disease patients and heart transplant recipient. The aim of the study was to evaluate the relationship between PAPP-A A plasma levels and the extent of coronary lesions in heart transplant recipients. The study included 37 heart transplant recipients. CAV was diagnosed in 23 recipients. Our results showed that PAPP-A plasma levels were higher in recipients with CAV, did not correlate with the duration of time after HTx but were associated with the extent of coronary lesion.

Orlova, O. V.1; Shevchenko, A. O.2; Kazakov, E. N.3; Kormer, A. J.3; Shevchenko, O. P.3 Author Information

Shevchenko, O. P.; Orlova, O. V.; Kazakov, E. N.; Kormer, A. J.; Shevchenko, A. O. Author Information

One of the most essential autoimmunity risk factors for development of CAD are increasing level of anticardiolipin antibodies and homocystein. This report presents retrospective analyses of 39 heart transplant recipients with maximal follow up over 16 years. Our results showed that hyperhomocystenemia and high levels of anticardiolipin antibodies play great value in development of CAD. Thus relative risks for development of CAD in presence both high levels of anticardiolipin antibodies and homocysteine are higher, than in traditional nonimmune risk factors.

A female patient T., 67 years, had a 30-year anamnesis of heart failure, HF (NYHA Functional Class III) with normal left ventricular ejection fraction and Stage II arterial hypertension. After thyroidectomy in 1987, the patient received L-thyroxin. The patient also received long-term standard antihypertensive therapy and HF treatment. Due to ineffective therapy and increased dyspnoea, radionuclide ventriculography was performed, suggesting restrictive cardiomyopathy. Intracoronary injection of autologous bone marrow stem cells was performed. Four months later, an improvement in clinical status (NYHA FC I) was associated with improved diastolic function at ventriculography. Immunological analysis confirmed a virus infection.

In transplanted hearts, peri-and postoperative ischemic and alloimmune stimuli may be interpreted as inadequate tissue perfusion leading to activation of angiogenic signaling. Placenta growth factor (PLGF) is a marker of neoangiogenesis, belonge to vascular endothelial growth factors (VEGF) family. It has been shown that PLGF serum levels are elevated during acute rejection and decrease after immunosuppressive therapy in pediatric heart transplant recipients. The study was aimed to investigate clinical and prognostic significance of PLGF in heart transplant recipients. 34 patients (pts) (42,5 +/- 8,5 years, 29 men and 5 women, 21 patient with dilated cardiomyopathy, 13 - with ischemic heart disease) underwent heart transplantation (HTx) and were examined before and after HTx. Our results showed that pretransplant PLGF is a marker of posttransplant cardiovascular risk. Revealing PLGF plasma level in recipients during the first year after HTx also has prognostic value concerning development of cardiovascular complications. In the remote terms (1-16 years) after HTx PLGF plasma levels were significantly higher in recipients with TxCAD than in recipients without TxCAD. These findings confirm participation of PLGF in damage of the transplanted heart vessels.

Humoral rejection of the cardiac allograft is still a challenging problem associated with high incidence of graft loss and patient mortality. These episodes of rejection are often more severe, and more difficult to treat, than classical acute cellular rejection. Hemodynamic compromise, in the absence of acute cellular rejection, called biopsy-negative rejection occurs in 10 to 20% of cardiac allograft recipients. The assessment of hemodynamic compromise can provide functional data in transplant patients that is complementary to myocardial biopsies if the biopsy can miss significant rejection. We present three cases of the biopsy-negative rejection. All patients have studied with gated SPECT phase analysis.