We. Katz et al., IMMEDIATE EFFECTS OF LUNG TRANSPLANTATION ON RIGHT-VENTRICULAR MORPHOLOGY AND FUNCTION IN PATIENTS WITH VARIABLE DEGREES OF PULMONARY-HYPERTENSION, Journal of the American College of Cardiology, 27(2), 1996, pp. 384-391
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.