IMMEDIATE EFFECTS OF LUNG TRANSPLANTATION ON RIGHT-VENTRICULAR MORPHOLOGY AND FUNCTION IN PATIENTS WITH VARIABLE DEGREES OF PULMONARY-HYPERTENSION

Objectives. This study sought to determine the immediate effects of lu ng transplantation on right ventricular morphology and function in pat ients with variable degrees of pulmonary hypertension and to evaluate these features as potential markers of immediate outcome. Background. Selected lung transplant recipients with severe preoperative pulmonary hypertension have previously been shown to have a reduction in right ventricular size and improved function at follow up evaluation. Method s. Thirty-two consecutive patients (mean [+/- SD] age 44 +/- 11 years) were prospectively classified into three groups according to their pr etransplantation pulmonary artery systolic pressure: severe pulmonary hypertensive group greater than or equal to 75 mm Hg, intermediate pul monary hypertensive group 40 to 74 mm Hg and non-pulmonary hypertensiv e group <40 mm Hg. Hemodynamic and transesophageal echocardiographic v ariables were measured immediately before and after lung transplantati on. Results. Pulmonary artery systolic and mean pressures markedly dec reased after transplantation in the severe pulmonary hypertensive grou p (from 115 +/- 26 to 45 +/- 19 mm Hg and from 76 +/- 14 to 31 +/- 11 mm Hg, respectively, both p < 0.05). Mean pulmonary artery pressure de creased in the intermediate group (from 34 +/- 7 to 26 +/- 7 mm Hg, p < 0.05). Right ventricular end-diastolic area, end-systolic area and e ccentricity index decreased in the severe pulmonary hypertensive group after transplantation. End diastolic area also decreased in the inter mediate pulmonary hypertensive group. Right ventricular fractional are a change was not significantly different between groups and did not ch ange consistently after transplantation. Three patients with severe pu lmonary hypertension who had continued depression of right ventricular function after transplantation died in the immediate postoperative pe riod. Conclusions. Lung transplantation is associated with an immediat e decrease in pulmonary artery pressures and right ventricular size an d normalization of septal geometry but variable changes in right ventr icular function. Continued depression of right ventricular fractional area change may be a potential marker of poor outcome.