Heart Transplant Final Year by Dr Heena.pdf

Its heart transplant written by Dr. Heena Parmar.

1. Heart Transplantation
Heart Transplantation 1
DR. Heena Parmar (PT)
(Cardio-MPT)

2. History
►In 1967 – first successful heart transplantation
was achieved in south Africa.
►Dr.Shumway of Stanford performed the greatest
number of operations using the orthotopic
technique.
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3. ►In 1974 – Bernard and his associates in south
Africa started to concentrate on heterotopic
technique.
►By this life expectancy of survival of heart
transplantation has improved.
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4. Heart Transplantation 4

5. Criteria….
►For the recipient:-
oEnd stage heart disease like secondary to
widespread coronary disease.
oRheumatic cardiomyopathy.
oPatient with incorrectable congenital
abnormalities.
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6. ► For the donor:-
oDonor must have suffered irreversible brain
damage like,
▪ intracranial haemorrhage.
▪Direct result of RTA.
►There must be no history of heart disease,
systemic infection or malignancy
►The donor should not have been on long term
medication which could adversely affected the
performance of heart
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7. Assessment
►For recipient:-
oThe patient should have no active infection
oA raised pulmonary vascular resistance is an
absolute contraindication for an orthotopic
heart transplantation.
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8. ►For the donor:-
oAny donor over 35 years of age must undergo
coronary angiography to preclude any
possibility of undetected coronary disease.
oCompatibility of size of the heart may be a
consideration between recipient and donor.
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9. ►Sometimes smaller hearts may be used for
heterotopic transplantation in adults.
►ABO blood group compatibility is essential.
►Cross matching of donor lymphocytes and
recipient serum is necessary in patient with
cytotoxic antibodies.
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10. Transportation
►It must be quick and easy.
►The donor heart is plunged into ice cold Hartmann’s
solution to cool it from the outside.
►The aorta is clamped and a medicut - 1 ampoule of
cardioplegia infusion is inserted into the aorta and
connected to a liter of Hartmann's solution.
►This is infused into the aortic root causing the heart to
stop suddenly.
►The donor heart is transported in hartmann’s solution ,
packed in three sterile bags and put into cool box
filled with ice.
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11. Techniques
1.Orthotopic technique.
2.Heterotopic technique-piggy back.
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12. Orthotopic technique
►The patient is placed on the cardiopulmonary
bypass.
►Cardectomy of the recipient heart is carried out
by division of the atria at their midlevel plane
and of the great vessels immediately above
semilunar valves.
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13. ►This leaves the wall of the recipient’s right and
left atria and intra-atrial septum in situ.
►They are anastomosed to the correspondingly
prepared structures of the donor heart.
►The sinoatrial node in the recipient’s right
atrium is retained and take care is taken to
preserve the integrity of the donor’s sinoatrial
node.
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14. Orthotopic technique
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15. Heterotopic technique
►The recipient’s heart is left in situ and the
donor heart is placed to the right of it.
►The superior and inferior venae cavae of the
donor heart are ligated.
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16. ►A longitudinal incision is made on the Donor’s right
atrium anterior and it connect to the SVC of
recipient’s heart .
►The donor’s left and right atria are anastomosed to
the respective atria of the recipient’s heart .
►An end to side anastomosis is performed between
the aorta and pulmonary artery of the donor to the
aorta and pulmonary of the recipient.
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17. Heterotopic technique
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18. Heart Transplantation 18
• For bi-ventricular support configuration, the PA is
connected, via a Dacron graft to the recipient’s PA.

19. Physiotherapy Management
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20. Pre-operative PT management
►Goals:-
oTo gain patient’s confidence.
oTo teach correct breathing control.
oTo minimize dyspnea.
oTo assist in the removal of secretions.
oTo improve general mobility.
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21. To gain patient’s confidence
►Give the psychological support.
►Explain effectiveness of pre-operative and post
operative PT treatment.
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22. To teach correct breathing control.
►Breathing exercise:-Diaphragmatic breathing exercise.
:-Pursed lip breathing exercise.
►establish a coordinated pattern of breathing:
▪Shorten expiratory phase and being inspiration before
the airways have a chance to close down.
▪Avoid accessory muscles involvement.
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23. Heart Transplantation 23

24. Heart Transplantation 24

25. To minimize dyspnea.
►Teach dyspnea reliving positions.
►Teach deep breathing.
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26. Heart Transplantation 26

27. Heart Transplantation 27

28. To assist in the removal of secretions.
►Teach how to cough effectively by,
oCoughing.
oHuffing.
oACBT.
oPEP devices
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29. Heart Transplantation 29

30. ACBT
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31. To improve general mobility.
►Full joint ROM maintained by active/active
assisted exercise of arms, legs, and trunk.
►Teaching postural awareness and correct sitting
position.
►General mobility exercises.
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32. Post operative PT management
►Problem list:-
oPain
oDecreased air entry
oRetained secretions
oReduced arm and leg movements
oDecreased mobility
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33. Goals
►To improve patient’s confidence.
►To clear and maintain lung fields.
►To prevent circulatory complications.
►To improve ROM.
►To improve muscle strength.
►To achieve early independent and return to
normal life.
►To encourage and improve exercise tolerance
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34. Day of operation
►Breathing exercise:- diaphragmatic breathing.
:- unilateral basal breathing.
►The patient will be encouraged to cough, the
physiotherapist supporting or patient can support
himself around the surgical site.
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35. Splinting technique
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36. ►Active leg exercise:- ATM
:- knee flexion and extension.
:- isometric quadriceps exercise.
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37. ►Day 1:-
oCheck all the parameters like blood pressure, ECG,
pulse rate, steady drainage.
oHuffing and coughing with adequate sternal support.
oArms and leg exercise in half lying.
oBreathing exercise.
►Breathing and leg exercise increase up to 5-8 times.
►The decided protocol followed by 2-3 times during
the day.
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38. ►Day 2:-
oCheck the charts, chest radiograph.
oTreatment should carried out in chair or bed.
oBreathing exercise.
oTeach positioning.
oUse of a ‘pedal machine’ is started for 1-2 minutes.
oNumber of time will increased as the patient is able.
oIf patient is unable to stand from chair then
encourage to do stand-ups, knee bends, heel raises.
oFirst walk with full support.
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39. ►Day 3:-
oWalking period is increased.
oWell applied bandage or firm stocking if graft
taken from leg.
oBreathing exercise.
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40. ►Day 4:-
oIf patient can walk 100 yards without shortness
of breath then stair climbing can begin.
oFirst climb only one way.
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41. ►Day 5:-
oStair climbing.
oWalking.
oTrunk exercises.
oCo-ordinated breathing exercise.
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42. ►Day 6:-
oAdvice home exercise like,
•Neck
•Shoulder girdle
•Arm and trunk movements.
►Walking should increases gradually each day
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43. ►Ergonomic advice:-
oNot drive for 6 weeks.
oAble to resume light or part time work after 2
months.
oAnd heavy work after 3 months.
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44. Exercycle program
►At first no resistance is used.
►Patient builds up to 4 minutes at 15kph or 35
revs per minute.
►This constitutes :- warm up
:- work load
:- cool down
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45. ►Warm up:- 2 minutes at 15kph
►Work load:- 1 minute at 20kph
►Cool down:- 2 minutes at 15kph
►As the patient becomes stronger the work load
time is increased or resistance may be added.
►The aim being to encourage the endurance and
strength without overtaxing the patient.
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