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The cardiovascular system, composed of the heart and blood vessels, is responsible for circulating blood throughout your body to supply the tissues with oxygen and nutrients. The heart is the muscle that pumps blood filled with oxygen and nutrients through the blood vessels to the body tissues. It is made up of: Four chambers (two atria and two ventricles) that receive blood from the body (the atria) and pump out blood to it (the ventricles). The right atrium receives blood from the body, which is low in oxygen and high in carbon dioxide. The right ventricle pumps the blood from the right atrium into the lungs to provide it with oxygen and remove carbon dioxide. The left atrium receives blood from the lungs, which is rich in oxygen.
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The left ventricle pumps the blood from the left atrium into the body, supplying all organs with blood. Blood vessels, which compose a network of arteries and veins that carry blood throughout the body. Arteries transport blood from the heart to the body tissues. Veins carry blood back to the heart. Four valves to prevent backward flow of blood. Each valve is designed to allow the forward flow of blood and prevent backward flow. An electrical system of the heart that stimulates contraction of the heart muscle.
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Anemia (low red blood cell count) There may be other reasons for your doctor to recommend heart transplantation.
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psychiatrist or psychologist. Additional team members may include a dietician, a chaplain, and/or an anesthesiologist. Components of the transplant evaluation process include, but are not limited to, the following: Psychological and social evaluation. Psychological and social issues involved in organ transplantation, such as stress, financial issues, and support by family and/or significant others are assessed. These issues can significantly affect the outcome of a transplant. Blood tests. Blood tests are performed to help determine a good donor match and to help improve the chances that the donor organ will not be rejected. Diagnostic tests. Diagnostic tests may be performed to assess your lungs as well as your overall health status. These tests may include X-rays, ultrasound procedures, computed tomography (CT scan), pulmonary function tests, and dental examinations. Women may receive a Pap test, gynecology evaluation, and a mammogram. Other preparations. Several immunizations will be given to decrease the chances of developing infections that can affect the transplanted heart. The transplant team will consider all information from interviews, your medical history, physical examination, and diagnostic tests in determining your eligibility for heart transplantation. Once you have been accepted as a transplant candidate, you will be placed on the United Network for Organ Sharing list. When a donor organ becomes available, heart recipients are selected based on the severity of their condition and their blood type. You will be notified and told to come to the hospital immediately so you can be prepared for the transplant. The following steps will precede the transplant: Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure. You will be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully and ask questions if something is not clear. You should begin to fast once you are notified that a heart has become available. You may receive a sedative prior to the procedure to help you relax. Based on your medical condition, your doctor may request other specific preparation.
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You will be asked to remove your clothing and will be given a gown to wear. An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed. Additional catheters will be inserted in your neck and wrist to monitor the status of your heart and blood pressure, as well as for obtaining blood samples. Alternate sites for the additional catheters include the subclavian (under the collarbone) area and the groin. A catheter will be inserted into your bladder to drain urine. If there is excessive hair at the surgical site, it may be clipped off. Heart transplant surgery will be performed while you are asleep under general anesthesia. A tube will be inserted through your mouth into your lungs. The tube will be attached to a ventilator that will breathe for you during the procedure. The anesthesiologist will continuously monitor your heart rate, blood pressure, and blood oxygen level during the surgery. The skin over the surgical site will be cleansed with an antiseptic solution. The doctor will make an incision (cut) down the center of the chest from just below the Adam's apple to just above the navel. The sternum (breastbone) will be divided in half with a special operating instrument. The doctor will separate the two halves of the breastbone and spread them apart to expose the heart. Tubes will be inserted into the chest so that the blood can be pumped through your body by a cardiopulmonary bypass machine (heart-lung machine). Once the blood has been completely diverted into the cardiopulmonary bypass machine for pumping, the diseased heart will be removed. The donor heart will be sewn into place. Once the new heart is in place, blood vessels will be connected. When the transplant procedure has been completed, the blood circulating through the cardiopulmonary bypass machine will be allowed back into the heart and the tubes to the machine removed. The heart will be shocked with small paddles to restart the heartbeat. Once your new heart begins to beat again, the physician will observe the heart to assess the function of the heart and to make sure there are no leaks where the blood vessels are connected. Temporary wires for pacing may be inserted into the heart. These wires can be attached to a pacemaker and your heart can be paced, if needed, during the initial recovery period. The sternum will be rejoined and sewn together with small wires. The skin over the sternum will be sewn back together. The incision will be closed with sutures or surgical staples. Tubes will be inserted into your chest to drain blood and other fluids from around the heart. These
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tubes will be connected to a suction device to drain fluids away from the heart. A sterile bandage or dressing will be applied.
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Nurses, pharmacists, dietitians, physical therapists, and other members of the transplant team will teach you how to take care of yourself once you are discharged from the hospital.
At home
Once you are home, it will be important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. The sutures or surgical staples will be removed during a follow-up office visit, if they were not removed before leaving the hospital. You should not drive until your doctor tells you to. Other activity restrictions may apply. Follow-up visits will be scheduled frequently after returning home from the hospital. These visits may include blood tests, chest X-ray, and biopsy (removal of tissue from the heart for examination under a microscope.) The transplant team will explain the schedule for these tests. The rehabilitation program will continue for many months. Notify your doctor to report any of the following: Fever and/or chills that may be a sign of infection or rejection Redness, swelling, or bleeding or drainage from the incision site Increase in pain around the incision site Difficulty breathing Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.
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Usually, several anti-rejection medications are given initially. The doses of these medications may change frequently, depending on your response. Because anti-rejection medications affect the immune system, people who receive a transplant will be at higher risk for infections. A balance must be maintained between preventing rejection and making you very susceptible to infection. Some of the infections you will be especially susceptible to include oral yeast infection (thrush), herpes, and respiratory viruses. You should avoid contact with crowds and anyone who has an infection for the first few months after your surgery. To assess for rejection of the new heart, you will likely undergo a routine right heart biopsy on a regular basis for a period of time. The biopsy procedure is typically done once a week in the early period after a transplant, then gradually changed to monthly or longer intervals. The biopsy procedures may be discontinued eventually. The right heart biopsy procedure may be done as an outpatient or as an inpatient if you are already in the hospital. The procedure involves a right heart catheterization. A special catheter (or biopsy forceps or bioptome) is placed into the right ventricle of the heart. A series of about four to six biopsy samples is taken using a biopsy catheter, and the tissue is analyzed in the lab for signs of rejection. If rejection is defined, your anti-rejection medications may be adjusted by your doctor. The biopsy procedure has its own instructions and risks.
Online resources
The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your doctor. Please consult your health care provider with any questions or concerns you may have regarding your condition. This page contains links to other websites with information about this procedure and related health conditions. We hope you find these sites helpful, but please remember we do not control or endorse the information presented on these websites, nor do these sites endorse the information contained here. American College of Cardiology American College of Chest Physicians
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National Heart, Lung, and Blood Institute (NHLBI) National Institutes of Health (NIH) National Library of Medicine United Network for Organ Sharing
Articles
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