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HEART TRANSPLANTATION
PART A
A heart transplant is an operation to replace a damaged or failing heart with a healthy
heart from a donor who's recently died. It may be recommended when a person's life is
at risk because their heart no longer works effectively.

A heart transplant may be considered if you have severe heart failure and medical
treatments are not helping. Conditions that may eventually require a heart transplant
include:

• coronary heart disease – a build-up of fatty substances in the arteries supplying

the heart, which block or interrupt blood flow to the heart
• cardiomyopathy – where the walls of the heart have become stretched, thickened
or stiff
• congenital heart disease – birth defects that affect the normal workings of the
heart

A heart transplant is a complex and risky procedure. Possible complications include:

• the immune system recognizing the transplanted heart as foreign and attacking
it (rejection)
• the donated heart failing to work properly (graft failure)
• narrowing of the arteries supplying the heart (cardiac allograft vasculopathy)
• side effects from the immunosuppressant medication, such as an increased
vulnerability to infections, weight gain and kidney problems

Many of these problems are treatable, although sometimes another heart transplant may
need to be carried out if possible. Most people can eventually return to their normal
activities after a heart transplant and experience a significant improvement in their
symptoms for many years. But it's a major operation and some of the complications can
be life threatening.

• 80 to 90 in every 100 people will live at least a year

• 70 to 75 in every 100 people will live at least 5 years
• 50 in every 100 people will live at least 10 years
Some people have survived for more than 25 years after a heart transplant.
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PART B

As donor hearts are scarce, you'll need to be assessed carefully to determine whether a
heart transplant is suitable if your doctor thinks you could benefit from a transplant. Not
everyone who could benefit from a heart transplant will be suitable for one.

This is because the operation places a major strain on the body and may mean the
risks outweigh the potential benefits. For example, you may be considered unsuitable
for a heart transplant if you:

• have irreversible damage to other organs, such as your kidneys

• have an active infection – this will need to be treated first, if possible
• have cancer – treatment to bring it under control (known as being in remission)
will usually be needed before a transplant is considered
• have damaged blood vessels as a result of diabetes
• are obese – you may need to lose weight before a transplant is considered
• drink alcohol excessively or smoke – you may need to stop before a transplant
is considered

Age is not a factor in determining whether a heart transplant is suitable, although they're
rarely performed in people over the age of 65 because they often have other health
problems that mean a transplant is too risky.

PART C

A heart transplant is carried out with you unconscious under general anesthetic, and
normally takes between 4 and 6 hours. You'll be connected to a heart-lung bypass
machine, which will take over the functions of the heart and lungs while the transplant
is being carried out. A thin, flexible tube called a catheter will also be inserted to drain
your bladder during and after the operation. During the procedure:

• a cut (incision) is made down your chest over your breastbone and the bone is
separated, allowing the surgeon to access your heart
• your heart is removed, leaving behind a section of the right and left atria, the 2
upper chambers of the heart
• the new heart is connected to the aorta, pulmonary artery and the atria
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You'll be taken off the bypass machine when your new heart starts beating. Your
breastbone will be closed with metal wires, and the tissues and skin will be closed with
stitches.

Once the transplant is complete, you'll be moved to an intensive care unit (ICU).A
machine called a ventilator will assist you with your breathing, and a tube will be
inserted into a vein to provide you with fluid and nutrients. These will normally be
removed after a few days.

A heart transplant is a major operation and there's a risk of several complications. Some
complications can occur soon after the procedure, while others may develop months or
even years later. The main risks associated with a heart transplant are described below.
One of the most common complications of a heart transplant is rejection of the donor
heart. This is where the immune system recognizes the transplanted heart as foreign and
attacks it. Rejection usually occurs in the days, weeks or months after the transplant,
although it can sometimes happen years later. Immunosuppressant medication can
reduce the risk of this happening, but cannot always prevent it completely.

One of the most serious complications that can occur soon after a heart transplant is the
donated heart fails and does not work properly. This is known as graft failure, or
primary graft dysfunction. It occurs in 5 to 10% of people who have had a heart
transplant and can be fatal.
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PART D
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Questions 1-7 For each question, 1-7, decide which text (A,B,C or D) the
Information comes from. You may use any letter more than once. In which text
can you can find information about.

1. Which medications have the mechanism of reduced cardiac allograft vasculopathy

after transplant?
2. Which is the most common serious complication that occur soon after a heart
transplant?
3. Which factors are unsuitable for a heart transplant?
4. What are the side effects of immunosuppressant medications?
5. Why heart transplants are carried out?
6. Post heart transplant considerations of stain medications?
7. How a heart transplant procedure performed?

Answer the questions,8-14,with a word or short phrase from the texts. Each answer
may include words, numbers or both.

8. What is the time duration for a heart transplant operation?

9. In which condition where the walls of the heart have become stretched, thickened or
shift?
10. What is the ratio of people live at least 10 years after surgery?
11. What will be used to close the breast bone after a heart transplant?
12. Which medications have the mechanism of positive inotropic effect?
13. Which machine will take over the functions of the heart and lungs during the
transplant?
14. Which medications have the post-transplant consideration of exaggerated
sensitivity?

Questions 15-20 .Complete each of the sentences, 15-20, with a word or short
phrase from one of the texts . Each answer may include words, numbers or both.

15. Immunosuppressant medication can reduce the risk of.............., but always prevent
it completely?
16. .........is not a factor in determining, whether a heart transplant is suitable?
17. A heart transplant is considered, if have............and the................are not helping?
18. The new heart is connected to the………………….during the transplant?
19. One of the most common complications of a heart transplant is the rejection of
the..............?
20. .....................medication blocks acetylcholine at parasympathetic sites?
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ANSWER KEY
1. D
2. C
3. B
4. A
5. A
6. D
7. C
8. 4 to 6 hours
9. cardiomyopathy
10. 50 in every 100
11. metal wires
12. Digoxin
13. heart-lung bypass
14. Adenosine
15. rejection
16. age
17. severe heart failure and medical treatments
18. aorta, pulmonary artery and the atria
19. donor heart
20. Atropine