Cardiopulmonary response to dynamic exercise after heart and combined heart-lung transplantation.

Banner, Nicholas R.; Lloyd, M H; Hamilton, Russell D.; Innes, J A; Guz, A.; Yacoub, Magdi H.

doi:10.1136/hrt.61.3.215

Cited by 69 publications

(23 citation statements)

References 22 publications

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“…This absence of recovery was found in the anesthetized and awake (rest and exercise) state. In human lung transplant patients, there appears to be recovery of the HBIR in the awake but not the anesthetized state, and there is no apparent plasticity in the cough reflex of these patients (2,44,85).…”

Section: Denervation Of Receptors In the Lungmentioning

confidence: 96%

Invited Review: Plasticity in the control of breathing following sensory denervation

Forster

2003

Journal of Applied Physiology

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Forster, H. V. Invited Review: Plasticity in the control of breathing following sensory denervation. J Appl Physiol 94: 784-794, 2003; 10.1152/japplphysiol.00602.2002.-The purpose of this manuscript is to review the results of studies on the recovery or plasticity following a denervation-or lesion-induced change in breathing. Carotid body denervation (CBD), lung denervation (LD), cervical (CDR) and thoracic (TDR) dorsal rhizotomy, dorsal spinal column lesions, and lesions at pontine, medullary, and spinal sites all chronically alter breathing. The plasticity after these is highly variable, ranging from near complete recovery of the peripheral chemoreflex in rats after CBD to minimal recovery of the Hering-Breuer inflation reflex in ponies after LD. The degree of plasticity varies among the different functions of each pathway, and plasticity varies with the age of the animal when the lesion was made. In addition, plasticity after some lesions varies between species, and plasticity is greater in the awake than in the anesthetized state. Reinnervation is not a common mechanism of plasticity. There is evidence supporting two mechanisms of plasticity. One is through upregulation of an alternate sensory pathway, such as serotonin-mediated aortic chemoreception after CBD. The second is through upregulation on the efferent limb of a reflex, such as serotonin-mediated increased responsiveness of phrenic motoneurons after CDR, TDR, and spinal cord injury. Accordingly, numerous components of the ventilatory control system exhibit plasticity after denervation or lesion-induced changes in breathing; this plasticity is uniform neither in magnitude nor in underlying mechanisms. A major need in future research is to determine whether "reorganization" within the central nervous system contributes to plasticity following lesion-induced changes in breathing.receptors; recovery of function; redundancy; chemoreflexes; mechanoreflexes DENERVATION OR LESIONING OF a receptor or neural pathway that normally contributes to the regulation of a physiological function will result in loss of or altered function. Thereafter, a time-dependent recovery of function is a manifestation of plasticity within the regulatory system. The purpose of this review is to summarize research on this type of plasticity within the system regulating breathing. Lesions are one of several means of inducing plasticity; a review of these and a general discussion of plasticity are presented elsewhere (66). Nevertheless, it seems appropriate to emphasize here that recovery of function can be due to restoration of the same mechanism or substitution of another mechanism. Also, recovery refers specifically to the return of a function, whereas plasticity refers to the process or mechanism of the restoration (i.e., capability of building new tissue or formative). A related phenomenon, redundancy, refers to two or more mechAddress for reprint requests and other correspondence:

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Section: Denervation Of Receptors In the Lungmentioning

confidence: 96%

Invited Review: Plasticity in the control of breathing following sensory denervation

Forster

2003

Journal of Applied Physiology

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“…However, they did point out that their findings do not rule out a possible important role for receptors in the remaining native trachea above the level of the anastomosis. The sensation of breathlessness during exercise [32,58], as well as detection of inspiratory resistive loads [59], is also normal following HLT. These observations indicate that pulmonary neurogenic mechanisms do not appear to contribute significantly to the perception of breathlessness in normal humans.…”

Section: Ventilatory Sensationmentioning

confidence: 99%

Lung transplant outcomes: a review of survival, graft function, physiology, health-related quality of life and cost-effectiveness

Studer¹

2004

Eur Respir J

163

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The success of lung transplantation has improved over time as evidenced by better long-term survival and functional outcomes. Despite the success of this procedure, there are numerous problems and complications that may develop over the life of a lung transplant recipient. With proper monitoring and treatment, the frequency and severity of these problems can be decreased. However, significant improvement for the overall outcomes of lung transplantation will only occur when better methods exist to prevent or effectively treat chronic rejection. Eur Respir J 2004; 24: 674-685.

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“…However, little information is currently available regarding the expected functional outcome [12][13][14][15], and not all studies have focused on results at a well-defined time-point. Even less information is available on skeletal and respiratory muscle function over time [13,15,16].…”

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confidence: 99%

Time course of exercise capacity, skeletal and respiratory muscle performance after heart-lung transplantation

Ambrosino

Bruschi

Callegari

et al. 1996

European Respiratory Journal

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T Ti im me e c co ou ur rs se e oof f e ex xe er rc ci is se e c ca ap pa ac ci it ty y, , s sk ke el le et ta al l a an nd d r re es sp pi ir ra at to or ry y m mu us sc cl le e p pe er rf fo or rm ma an nc ce e a af ft te er r h he ea ar rt t--l lu un ng g t tr ra an ns sp pl la an nt ta at ti io on n N. Ambrosino*, C. Bruschi, G. Callegari, S. Baiocchi, G. Felicetti, C. Fracchia, C. RampullaTime course of exercise capacity, skeletal and respiratory muscle performance after heart-lung transplantation. N. Ambrosino, C. Bruschi, G. Callegari, S. Baiocchi, G. Felicetti, C. Fracchia, C. Rampulla. ERS Journals Ltd 1996. ABSTRACT: Recipients of heart-lung transplantation (HLT) show reduced exercise capacity due to several pre-and postsurgical factors. The aim of this study was to evaluate the time course of exercise capacity, and skeletal and respiratory muscle performance in 11 patients (5 females and 6 males; age (mean±SD) 38±13 yrs) undergoing HLT. All of the patients were admitted to our institution for a rehabilitation programme after surgery, and were followed-up for 18 months. On admission, at discharge after an in-patient rehabilitation programme, and every 6 months, patients underwent evaluation of: lung function values; incremental treadmill exercise, 6 min walking distance (6-MWD); maximal inspiratory and expiratory pressures (MIP and MEP, respectively); and peak torque of isokinetic contraction of leg flexor and extensor muscles (IFX and IEX, respectively).On admission, patients had: reduced lung volumes as assessed by vital capacity (VC) (60±15% of predicted); reduced exercise capacity as assessed by peak oxygen consumption (V ' 'O 2 ,peak) (40±12% pred); reduced skeletal and respiratory muscle performance as assessed by IEX, IFX (48±16 and 28±12 Newton-metres (N×m), respectively) and by MIP and MEP (54±21 and 58±19 cmH 2 O, respectively). Ten patients completed the rehabilitation programme. At discharge, no significant change in dynamic and static lung volumes was observed. However, nonsignificant increases in MIP, MEP, IEX, IFX, 6-MWD and V ' 'O 2 ,peak were recorded. After 6 and 12 months, indices of skeletal and respiratory muscle function and V ' 'O 2 ,peak improved further, but still remained lower than normal values.We conclude that in patients with heart-lung transplantation, skeletal and respiratory muscle function and exercise performance are reduced after surgery, that they may improve with time but are still less than normal after 18 months.

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Cardiopulmonary response to dynamic exercise after heart and combined heart-lung transplantation.

Cited by 69 publications

References 22 publications

Invited Review: Plasticity in the control of breathing following sensory denervation

Invited Review: Plasticity in the control of breathing following sensory denervation

Lung transplant outcomes: a review of survival, graft function, physiology, health-related quality of life and cost-effectiveness

Time course of exercise capacity, skeletal and respiratory muscle performance after heart-lung transplantation

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