E. B. STINSON, P. L. TECKLENBERG, J. F. HOLLINGSWORTH AND K. W. JONES 
687 
pressure curves observed in constrictive or re- 
strictive heart disease. Since these modifications 
in diastolic filling pattern v^^ere independent of 
concomitant changes in absolute dimensions 
and heart rate, and were not associated with 
apparent alterations of ventricular geometry, 
they may be interpreted as indicative of re- 
duced myocardial compliance. This hypothesis 
is compatible with the gross and microscopic 
pathologic findings in acute cardiac graft rejec- 
tion, namely, firm, rubbery, thickened ventricu- 
lar walls, severe myocardial edema, vascular 
congestion, and cellular infiltration. Such fea- 
tures would be expected to produce significant 
changes in the elastic properties of the ventric- 
ular myocardium. It is noteworthy that in two 
animals distortion of the diastolic diameter 
waveform developed concurrently with a de- 
crease in QRS voltage, before the onset of sig- 
nificant hemodynamic deterioration. 
SUMMARY 
These studies demonstrate that acute rejec- 
tion of orthotopically transplanted hearts in un- 
treated dogs is associated with progressive 
hemodynamic impairment which develops rela- 
tively late in the postoperative course and is ex- 
pressed primarily in the limitation of stroke 
volume. The results of additional studies of 
transverse internal left ventricular diameter 
during rejection suggest that the decline in ven- 
tricular performance is due primarily to de- 
pression of the graft contractile state. De- 
creases in electrocardiographic voltage and 
alterations in the pattern of donor left ventricu- 
lar diastolic filling generally preceded hemody- 
namic deterioration. 
REFERENCES 
1. Stinson, E. B., Dong, E., Jr., Bieber, C. P., 
Schroder, J. S., and Shumway, N. E. Cardiac 
transplantation in man. I. Early rejection. J.A.M.A. 
207:2233, 1969. 
2. Williams, G. M., DePlanque, B., Braham, W. H., 
and Lower, R. R. Participation of antibodies in 
acute cardiac-allograft rejection in man. New Eng- 
land J. Med. 281:1145, 1969. 
3. Lower, R. R., and Shumway, N. E. Studies on 
orthotopic transplantation of the canine heart. 
Surg. Forum 77:18-20, 1960. 
4. Stinson, E. B., Rahmoeller, G., and Tecklen- 
berg, P. L. Measurement of internal left ventricu- 
lar diameter by tracked ultrasound. In preparation. 
5. Schuette, W. H., and Simon, A. L. A new device 
for recording cardiac motion. Med. Res. Eng. 7:25, 
1968. 
6. KosEK, J. C, Hurley, E. J., and Lower, R. R. 
Histopathology of orthotopic canine cardiac homo- 
grafts. Lab. Invest. 19:97, 1968. 
7. Levine, H. J. Muscle mechanics in the in-situ 
heart. In: Factors Influencing Myocardial Contrac- 
tility. (Eds. R. D. Tranz, F. Kavaler, J. Roberts.) 
Academic Press, New York, p. 93, 1967. 
8. Lower, R. R., Dong, E., Jr., and Shumway, N. E. 
Long-term survival of cardiac homografts. Surg. 
58:110-119,1965 
9. Lower, R. R., Stofer, R. C, and Shumway, N. 
E. Homovital transplantation of the heart. J. 
Thorac. and Gardiovasc. Surg. 41:196, 1961. 
10. Chartrand, C., Angell, W. W., Dong, E., Jr., 
and Shumway, N. E. Atrial pacing in the post- 
operative management of cardiac homotrans- 
plantation. Ann. Thorac. Surg. 8:152-160, 1969. 
11. Stinson, E. B., Griepp, R. B., Bieber, C. P., and 
Shumway, N. E. Hemodynamic observations after 
orthotopic transplantation of the canine heart. J. 
Thorac. Gardiovasc. Surg. 63:344-352, 1972. 
DISCUSSION 
Chairman Frank J. Veith: Have you cor- 
related the findings that you've presented with 
the simple parameters of white count and tem- 
perature? It would appear from our observa- 
tions in man that temperature is an excellent 
index of early acute rejection with lung and 
kidney allografts. Is the same true of heart allo- 
grafts, or is the EKG a beautiful and sensitive 
index clinically? 
Dr. Stinson: Several years ago Dr. Lower 
and Dr. Dong of Dr. Shumway's laboratory 
proved the electrocardiogram to be the most re- 
liable index of rejection in animals. The initial 
studies in the early 1960's on the correlation of 
white blood cell count, lymphocyte percentages, 
and dog temperatures were quite useless in mon- 
itoring rejection. I'm afraid that the picture is 
clouded in man, as it usually is, by the variety * 
of clinical variables. For instance, we find that 
the administration of antilymphocyte or anti- 
thymocyte globulin is so regularly associated 
with fever that it completely abrogates body 
temperatures as any index of hematologic re- 
sponse. 
