Ventricular unloading caused clinical, functional, and hemodynamic improvements accompanied by improvements in sympathetic innervation in the failing heart.

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It is not known whether surgical denervation leads to increased fl-receptor sensitivity after human cardiac transplantation. We assessed cardiac ,8-receptor sensitivity by studying the heart rate response to isoprenaline of the denervated donor heart as compared with the innervated recipient heart in eight patients who underwent heterotopic cardiac transplantation and in six patients with orthotopic transplantation. Changes in the donor and recipient hearts seen in these 14 patients were further compared with those seen in 10 normal volunteers. Incremental intravenous infusion of isoprenaline (5, 10, and 15 ng/kg/min) raised heart rate to a greater extent in the donor compared with the recipient hearts in the eight patients who had heterotopic grafts (slopes [beats/min/ng/kg]: donor = + 2.26, recipient = + 1. 59; p < .01). In addition, the donor hearts of the transplant patients were more sensitive than hearts of the normal volunteers (slopes: donor = + 2.26, normal = + 0.94; p < .01). The changes in the two groups of donor hearts were similar (slopes: orthotopic = + 2.24, heterotopic = + 2.27; NS). The recipient hearts in the patients with heterotopic transplants were more sensitive than the hearts of the normal volunteers (p < .05), suggesting that the observed differences in isoprenaline sensitivity in the patients with heterotopic grafts were not caused by a decreased sensitivity of the recipient heart. After fl-blockade, the heart rate responses to isoprenaline were attenuated to the same extent in denervated and innervated hearts. The donor hearts, however, continued to be more sensitive to isoprenaline than were the recipient hearts (slopes: donor = + 0.72, recipient = + 0.34; p < .01). In patients with cardiac transplantation, the denervated heart is more sensitive to the chronotropic effect of isoprenaline compared with the innervated hearts of both the recipients and normal volunteers. However, since ,8-blockers attenuated this response similarly in the denervated and innervated hearts, our observations are consistent with an increase in fl-receptor density and probably no change in fl-receptor affinity. Circulation 75, No. 4, 696-704, 1987.

Three patients with recurrent bronchial stenosis following single lung transplant (SLTx), and one patient with tracheal stenosis following heart-lung transplantation (HLTx), not responding to repeated dilatations (3 patients) and prolonged use of silastic stents (patient with tracheal stenosis), have been treated by the endoscopic insertion of Gianturco self-expanding metallic stents under fluoroscopic control. The stent resulted in immediate improvement in respiratory function in all four patients. One patient (SLTx) had early bronchial re-stenosis due to growth of granulation tissue within the stent which was successfully treated by cryotherapy. In one patient (HLTx), a left lower lobe bronchial stenosis developed 14 months after tracheal stenting. The metallic stent appears to be a promising device in the management of recurrent or resistant bronchial stenosis following SLTx or tracheal stenosis after HLTx.

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