There is little information on the hemodynamic response to upright exercise in patients who have undergone cardiac transplantation. We compared the hemodynamic and metabolic response to upright bicycle exercise in 11 patients with heart transplants and 12 controls. Patients performed two tests—a steady‐state test with a right heart catheter and a maximal incremental test. During steady‐state exercise at 20% of their predicted maximum workload, patients with heart transplants had a higher (mean ± SD, p < 0.05) heart rate (108 ± 11 vs. % ± 15 beats/min), mean systemic blood pressure (116 ± 17 vs. 101 ± 11 mmHg), mean pulmonary artery pressure (29 ± 9 vs. 22 ± 3 mmHg), mean pulmonary wedge pressure (14 ± 6 vs. 9 ± 2), pulmonary (302 ± 101 vs. 220 ± 50 d‐sec‐cm−5 ‐ m2) and systemic (2049 ± 531 vs. 1459 ± 520) resistance indices, and lactate concentration (3.4 ± 1.7 vs. 1.7 ± 0.4 mmol/1), and a lower stroke index (39 ± 8 vs. 50 ± 8 ml/m2) compared with controls. Cardiac index, right atrial pressure, and mixed venous oxygen saturation were similar. During the maximal exercise test, patients with heart transplants achieved a significantly lower percentage of predicted maximum heart rate (77 ± 13 vs. 91 ± 8%), workload (70 ±25 vs. 102 ± 23%), oxygen consumption (63 ± 11 vs. 108 ± 19%), and ventilation (67 ± 18 vs. 89 ± 15%) compared with controls. Heart transplant patients also had a lower blood pressure and anaerobic threshold. We conclude that heart transplant patients have an altered hemodynamic and metabolic response to upright bicycle exercise.

Two-dimensional ultrasonography and color Doppler were used over an 18-month period for the diagnosis and management of femoral artery pseudoaneurysms in six patients with pulsatile groin masses found after catheterization. A diagnosis of pseudoaneurysm was made when color Doppler demonstrated pulsatile systolic flow into echolucent masses. One patient underwent surgical repair of a symptomatic pseudoaneurysm after the initial Doppler study. Serial color Doppler studies were performed in five subjects, all of whom showed resolution of flow after a mean of 18 days (range 7 to 42). Despite an absence of flow, one patient underwent surgical drainage of persistent hematoma. After a mean interval of 233 days (range 84 to 552) all patients have remained free of other complications or symptoms related to the pseudoaneurysm. This experience suggests that urgent surgical repair is not required in all cases of small iatrogenic pseudoaneurysms, and that asymptomatic patients can be safely followed with serial color Doppler examinations.

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