Heart transplantation has been a clinical program at Hartford Hospital for the past 15 years, resulting in 206 transplants. The five-year survival rate is 69% and is 43% at 10 years. The first recipient is surviving and has had full rehabilitation. Thirteen patients have survived 10 years or more. Advances in immunosuppression are ongoing and will result in further long-term survivors. Graft vasculopathy and lack of organ donation are current problems.

Three patients with severe chronic lung disease had left ventricular failure develop with marked impairment of cardiac function. Ejection fractions by radioactive blood pool ventriculography were 0.17, 0.24, and 0.20. Right ventricular endomyocardial biopsy specimens showed interstitial hemorrhage and foci of interstitial polymorphonuclear leukocytes, strongly suggestive of catecholamine myocarditis. These patients had used beta-adrenergic agonist inhalants and methylxanthines. One of them clearly abused the inhalant and had elevated levels of urinary catecholamines. Progressive deterioration of pulmonary and cardiac function occurred in two patients, with death within three months of the initial myocardial biopsy. Concomitant use of beta-adrenergic agonists and methylxanthines may cause myocarditis with left ventricular failure in susceptible patients.

A single view, wedge, pulmonary angiogram was performed at bedside in nine patients using a Swan-Ganz catheter which had been inserted previously for other indications. Criteria for consideration of a bedside study were as follows: (1) a clinical suspicion of significant, acute pulmonary embolism; (2) the inability or inadvisability of transferring the patient for definitive studies; and (3) a Swan-Ganz catheter in situ. Seven of the nine patients subsequently died. Of five patients who underwent necropsy, three positive studies and one negative, were confirmed. No post-mortem evidence for embolism could be demonstrated in one patient with a positive study. Of the two patients who survived, one negative study was confirmed with a negative radionuclide perfusion lung scan. There was no morbidity or mortality associated with the procedure. These data suggest that this technique is safe and has a role in the early diagnosis of significant pulmonary embolism in selected critically ill patient.