心 移植

准备

Your heart specialist may ask that you be evaluated for a heart transplant if he or she believes that your heart disease is so advanced that there are no other treatment options and that you would be a good candidate for this surgery.

A number of different conditions can damage your heart to the point where other treatments are unsuccessful and a transplant is the best chance for cure. 这些包括:

• 先天性心脏病
• 冠状动脉疾病
• 心脏衰竭
• 肺动脉高压
• 心脏瓣膜病

其他情况可能使患者不考虑移植, 如不可逆肺动脉高压, 癌症, 艾滋病毒, 药物或酒精成瘾, 由于营养不良导致的急性智力低下和严重的肌肉损失, 叫做心脏恶病质. 在个体基础上评估一些其他十大赌博靠谱网络平台以确定移植的适宜性.

一旦确定你将从移植手术中获益, 你的名字会被列在等待移植心脏的名单上. 目前没有足够的捐献心脏供需要的人使用. 根据国家规定，在特定地区，心脏必须首先流向病情最严重的病人.

Research currently is being done to evaluate devices that potentially could act as a "bridge" to transplantation by replacing heart function with a machine until a donor heart is available.

评价

Our staff will determine your general suitability for transplantation using preliminary information from your referring doctor. 在初步评估之后，将进行非常全面的评估. Our approach to this is flexible although we do insist that every potential candidate and their family visit UCSF Medical Center at least once before the transplant.

所有候选者都由加州大学旧金山分校的移植团队进行治疗，其中包括一名心脏病专家, 外科十大赌博平台排行榜, 移植协调员和社会工作者. 如果病人住得离旧金山很远, the team works with the referring doctor to complete portions of the pre-transplant selection protocol in your local community.

移植前的评估包括心脏和心脏外系统的评估. 病情稳定的患者通常能够在门诊完成标准的移植前选择方案.

心脏评估最重要的组成部分之一是肺血管健康的评估. 如果病人有肺动脉高压, 确定其严重程度和治愈可能性至关重要. These trials are conducted in the hospital with right heart catheterization and continuous hemodynamic monitoring often for periods of six to 12 hours. 因为这些试验的结果是决定病人是否适合移植的关键, 我们倾向于在UCSF医疗中心进行这部分评估.

心脏评估的其他常规内容包括:

• 非侵入性研究评估心肌的功能, 包括超声心动图和放射性核素扫描.
• 灌注测试, 哪一种测量流向组织的血流量, 包括静息和应激放射性核素扫描或超声心动图.
• 在标准运动研究中最大摄氧量的测量.

一些患者可能还需要正式的心导管插入术, 包括冠状动脉造影和心室造影, 心肌活检和电生理检查.

除了, 移植前评估包括一些与心脏无关的测试和其他部分, 包括:

• 肺功能检查包括肺活量测定和动脉血气.
• 肾脏和肝脏功能的实验室检查.
• 采访社工，器官移植协调员和精神科十大赌博平台排行榜.
• 与十大赌博平台排行榜管理层就财务安全问题进行访谈.
• 传染病筛查，包括血清学和皮肤测试.
• 免疫遗传学包括血液和组织分型以及检查你的人类白细胞抗原(HLA)水平.
• Cancer screening that includes chest X-rays and stools samples for everyone; mammograms, breast and pelvic exams for women; and prostate-specific antigen (PSA) and prostate exams for men.

根据您的具体情况，在初始筛选期间可能会运行额外的测试.

While the main focus of the evaluation is to determine whether the patient is a suitable candidate for transplantation, 该团队还与患者及其家属合作，解决任何可能可逆的情况，如吸烟, 药物之外, 肥胖, 精神上的痛苦, 财政问题等等.

The selection of patients for heart transplantation is based on a recommendation from the multidisciplinary heart transplant team that is comprised of representatives from various departments including surgery, 内科医学, 护理, 精神病学, 社会工作, 病理与十大赌博平台排行榜管理. The potential heart transplant candidate's case is presented at the weekly transplant meeting after the members of the team complete the interviewing process and the patient completes all pre-transplant testing.

在此讨论之后，团队将决定执行以下操作之一:

• 接受病人进行移植.
• 暂时接受病人，等待一个或多个小问题的解决.
• Not accept the patient at the present time but recommend that he or she be followed with possible reconsideration at a future date.
• 绝对不接受病人.

委员会的所有决定都是基于小组的一致意见. 在困难的情况下，医疗中心的伦理委员会可以提供他们的专业知识.

等待捐赠的心脏

病人 deemed to be acceptable candidates for transplantation are listed nationally with the California 移植 Donor Network. 根据需要的机构进行列名, 心脏或心脏和肺, 血型和可接受的供者身高范围. 捐献心脏的分配在地方和区域一级严格按照国家政策进行. 这一政策的两个主要特点包括:

• 病人 who require combined heart and lung transplantation are given priority over those requiring isolated heart transplantation.
• 心 transplant recipients are prioritized according to the duration of time that they have been "actively" on the waiting list.

大多数病人继续从当地社区的十大赌博平台排行榜那里得到所有的医疗服务. 少数人选择将他们的护理转移到加州大学旧金山分校医疗中心. 无论哪种情况，我们都会与患者的转诊十大赌博平台排行榜保持密切联系.

All patients on the waiting list are seen by the transplant cardiologist and transplant coordinator in the outpatient clinic every three months or as dictated by his or her medical condition. 在这些访问期间，重新评估患者是否继续适合移植, 如果有必要的话, 进行进一步的医疗咨询或研究. 这些访问通常与移植计划支持小组每月的会议同时进行, 哪些等候名单上的病人被鼓励参加.

Local doctors immediately inform the transplant team if a medical condition arises that could affect the patient's transplantation eligibility. 如果病人的临床情况允许的话, 他们可能会暂时或永久地从“活跃的”等待名单中删除. 病人 whose clinical condition deteriorates while on the waiting list are either admitted directly or transferred to UCSF Medical Center from the community hospital once his or her condition has stabilized.

移植项目可以使用多种药物和设备, 包括心脏起搏器, 除颤器和心室辅助装置, 支持患有严重心脏病的病人直到他们可以移植.

UCSF Medical Center is a member of the 器官共享联合网络 (UNOS) and a founding member of the California 移植 Donor Network (CTDN), 一个由区域移植中心支持的独立的区域器官采购组织. The network has developed and maintains working relationships with more than 150 hospitals in Northern and Central California as well as Northern Nevada where it assists in the identification of potential donors, 提供捐赠者管理, 采购, 保存, transportation and distribution of donor organs as well as formal and informal education concerning organ donation and transplantation.

过程

心 transplant surgery involves removing most of your diseased heart and inserting one from a person who has died. 一旦你被分配到捐赠的心脏，你将被立即通知到十大赌博平台排行榜. 在到达时, 你要去冠状动脉监护室做身体检查和其他检查, 包括血液和尿液样本.

你将为手术做好准备, which includes the insertion of intravenous lines and a catheter in your neck to measure the pressure in your heart.

你会被麻醉，这样你就可以在手术过程中睡觉了. You also will receive immunosuppressive drugs before and during the procedure to prevent your body from rejecting the new heart.

手术包括:

• 胸部有个大切口. 你的胸骨被劈成了两半.
• Your main arteries are connected to a heart lung bypass machine to pump your blood and a ventilator will help you breathe.
• 大多数心脏移植是通过一种叫做原位手术的方法完成的, 你的心脏大部分都被切除了只剩下两个上腔的后半部分, 被称为心房, 都留在原地. 然后将供体心脏的前半部分缝合到旧心脏的后半部分.
• 捐赠者的主动脉和肺动脉与你的相连. 旁路机器断开，你的新心脏开始泵血.
• 你的切口闭合了.

这种手术被认为比大多数心脏搭桥手术更简单, 包括冠状动脉旁路移植术.

复苏

手术后, 你将在一个特殊的无菌室里醒来，以确保你不会受到感染. Staff and visitors must take measures to make sure that they do not bring in bacteria and infections by scrubbing their hands and wearing protective masks and gowns.

一旦你能自己呼吸，呼吸机就会被取下. 然而，你将继续连接到各种监视器和导管一段时间. 当你更强壮时，你可能会被转移到更普通的病房.

你将不得不采取预防措施，以防止你的余生暴露于感染. 你在十大赌博平台排行榜康复的其余大部分时间将包括有关照顾自己的教育和培训. 这包括了解你需要服用的抗排斥药物, 如何遵循有利于心脏健康的低脂饮食和其他改变.

如果你没有任何并发症，你将在十大赌博平台排行榜住10天左右.

出院后

一旦你离开十大赌博平台排行榜，你将需要定期的随访来监测你的进展. 移植后的头两个月, 你需要每一到两周去看一次十大赌博平台排行榜.

如果一切顺利，6个月后，每隔一到两个月进行一次访问. 一年后，这些访问可能会减少到三到六个月的间隔. Follow-up care is tracked by computer on a quarterly basis; both routine and crisis visits are monitored for all patients.

您将能够逐渐恢复正常的活动. 当你的胸骨, 或胸骨, 完全痊愈了, 这大约需要六周的时间. 你可以在移植手术后两到三个月返回工作岗位. 心脏移植手术一般需要三到六个月才能完全恢复. 然而，年龄和既往病史问题可能会导致恢复期延长.