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      Impact of Pulmonary Vascular Resistances in Heart Transplantation for Congenital Heart Disease

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          Abstract

          Congenital heart disease is one of the major diagnoses in pediatric heart transplantation recipients of all age groups. Assessment of pulmonary vascular resistance in these patients prior to transplantation is crucial to determine their candidacy, however, it is frequently inaccurate because of their abnormal anatomy and physiology. This problem places them at significant risk for pulmonary hypertension and right ventricular failure post transplantation. The pathophysiology of pulmonary vascular disease in children with congenital heart disease depends on their pulmonary blood flow patterns, systemic ventricle function, as well as semilunar valves and atrioventricular valves structure and function. In our review we analyze the pathophysiology of pulmonary vascular disease in children with congenital heart disease and end-stage heart failure, and outline the state of the art pre-transplantation medical and surgical management to achieve reverse remodeling of the pulmonary vasculature by using pulmonary vasodilators and mechanical circulatory support.

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          Most cited references94

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          The pathology of hypertensive pulmonary vascular disease; a description of six grades of structural changes in the pulmonary arteries with special reference to congenital cardiac septal defects.

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            A platelet-dependent serum factor that stimulates the proliferation of arterial smooth muscle cells in vitro.

            Dialyzed serum from clotted monkey blood ("blood serum") promotes the proliferation of monkey arterial smooth muscle cells in culture, but dialyzed serum prepared from recalcified platelet-poor plasma ("plasma serum") is much less effective. Addition of platelets and calcium to platelet-poor plasma increases the activity of plasma serum to the same level achieved with blood serum. Furthermore, addition to plasma serum of a platelet-free supernatant prepared by exposing purified platelets to thrombin also stimulates the proliferation of smooth muscle cells. Thus, much of the growth-promoting activity of dialyzed serum is directly or indirectly derived from platelets. This finding has important implications for the response of arteries to localized injury and provides a key to further understanding of the role of factors derived from blood serum in promoting cell proliferation in vitro.
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              Solvent viscosity and protein dynamics.

              Proteins are dynamic systems. Recent evidence demonstrates that they exist in a large number of conformational substates and can continuously move from one substate to another; motion of a small ligand inside a protein may be possible only through these conformational fluctuations. To test this idea, we study with flash photolysis the binding of CO to protoheme and O2 and CO to myoglobin in many different solvents. The standard evaluation of such experiments yields information only about the protein-solvent system. A novel approach is presented which permits conclusions concerning the protein: Data from all solvents are considered together, and the rates for transitions of the ligand over various barriers are studied as a function of temperature for fixed solvent viscosities. Results show that over a wide range in viscosity the transition rates in heme-CO are inversely proportional to the solvent viscosity and can consequently be described by the Kramers equation. The rates of O2 and CO in myoglobin also depend on the solvent viscosity and are most sensitive to the solvent at the lowest viscosity. Viscosity influences protein reactions even in aqueous solutions. The data dan be interpreted by a dynamic model in which transitions into and inside myoglobin are governed by fluctuations between conformational substates corresponding to closed and open pathways. Ligand motion thus is mainly controlled by gates and not by static potential barriers. Some characteristic parameters for the substates are determined, and they agree approximately with similar parameters found in Mössbauer experiments. As expected, the barrier parameters evaluated in the novel approach deviate markedly from the ones obtained by the conventional procedure. Comparison with model calculations or basic theories will be meaningful only with the new evaluation, and the method may be essential for many or possibly all biochemical reactions.
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                Author and article information

                Journal
                Curr Cardiol Rev
                CCR
                Current Cardiology Reviews
                Bentham Science Publishers
                1573-403X
                1875-6557
                May 2011
                : 7
                : 2
                : 59-66
                Affiliations
                [1 ]Divisions of Critical Care and Cardiology, Department of Pediatrics, Saint Louis Children’s Hospital, Washington University in Saint Louis, Missouri, USA
                [2 ]Division of Cardiology, Department of Pediatrics, Saint Louis Children’s Hospital, Washington University in Saint Louis, Missouri, USA
                Author notes
                [* ]Address correspondence to this author at the Divisions of Critical Care and Cardiology, Department of Pediatrics, Saint Louis Children’s Hospital, Washington University in Saint Louis, One Children’s Place, NWT/8 th floor, Saint Louis, Missouri 63110; Tel: (314) 286-1246; Fax: (314) 361-0733; E-mail: gazit_a@ 123456kids.wustl.edu
                Article
                CCR-7-59
                10.2174/157340311797484213
                3197090
                22548028
                44b706d4-8056-4c75-a50b-51c7d4508064
                © 2011 Bentham Science Publishers

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.5/), which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 December 2010
                : 23 May 2011
                : 27 June 2011
                Categories
                Article

                Cardiovascular Medicine
                pulmonary vascular resistance,congenital heart disease,heart transplantation.

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