tailieunhanh - 100 Questions in Cardiology - Part 7

suy hô hấp nặng, mặc dù điều trị y tế tối đa 2 nặng bị suy giảm chất lượng cuộc sống của bệnh nhân 3 tích cực muốn ghép. Chỉ có bệnh nhân những người đã xấu đi suy hô hấp mãn tính nên được chấp nhận vào danh sách chờ. Trong thực tế, thể tích thở ra buộc trong một giây thường là ít hơn 30% giá trị dự đoán | 126 100 Questions in Cardiology 3 New York Heart Association class III or IV 4 Non-transplant cardiac surgery considered unfeasible 5 Heart failure resulting from one of the following Ischaemic heart disease Cardiomyopathy Valvular heart disease Congenital heart disease. Lung transplantation - indications 1 Severe respiratory failure despite maximal medical therapy 2 Severely impaired quality of life 3 Patient positively wants a transplant. Only patients who have deteriorating chronic respiratory failure should be accepted on to the transplant waiting list. In practice the forced expiratory volume in one second is usually less than 30 of the predicted value. Careful psychological assessment is necessary to exclude patients with intractable psychosocial instability that may interfere with their ability to cope with the operation and to comply with the strict post operative follow up and immunosuppressive regimes. In most centres the upper age limit is 60 years for cardiac transplantation and for single lung transplantation and 50 years for heart-lung and bilateral lung transplantation. Contraindications for cardiac and lung transplantation 1 Psychosocial instability and poor compliance 2 Infection with hepatitis B or C virus or with human immunodeficiency virus 3 Active mycobacterial or aspergillus infection 4 Active malignancy patient must be in complete remission for more than five years after treatment 5 Active peptic ulceration 6 Severe osteoporosis 7 Other end-organ failure not amenable to transplantation . hepatic failure or renal failure creatinine clearance 50mls min . Incremental risk factors for pulmonary transplantation include previous thoracic surgery and pleurodesis and patients are not accepted on to the waiting list who are on long term prednisolone 100 Questions in Cardiology 127 therapy in excess of 10mg d. Additional contraindications for cardiac transplantation include pulmonary vascular resistance greater than 3 Wood units and severe lung .