VARIABILITY OF RIGHT-VENTRICULAR FUNCTIONAL RECOVERY AFTER LUNG TRANSPLANTATION

Background. The purpose of this study was to assess by echocardiograph y the effects of lung transplantation on recovery of right ventricular (RV) function in patients with preoperative RV dysfunction. Methods. Fourteen (20%) of 71 lung transplant recipients were identified by ech ocardiography as manifesting abnormal RV function before lung transpla ntation, These 14 patients were selected for follow-up echocardiograph ic study 8 months after transplantation. Results, RV function improved significantly in the study group, Mean RV end-diastolic area decrease d from 26.8+/-7.9 cm(2) to 20.1+/-4.7 cm(2) (P<0.01); mean RV end-syst olic area decreased from 21.5+/-6.8 cm(2) to 13.1+/-4.2 cm(2) (P<0.01) ; and mean RV fractional area change (FAC) increased from 20.4+/-3.3% to 35.8+/-8.9% (P<0.001). A subgroup of four patients, however, exhibi ted no change in RV function, Patients who achieved improvement in RV function tended to be younger, had shorter duration of disease before transplantation, and had higher pulmonary arterial (PA) pressures befo re transplantation (PA systolic, 89+/-28 mmHg vs, 38+/-11 mmHg, P<0.00 1; PA diastolic, 42+/-11 mmHg vs. 19+/-3 mmHg, P<0.002). Each of the e ight patients with primary pulmonary hypertension exhibited improvemen t in RV function (mean Delta FAC +20.6+/-5.9%), while two of three pat ients with emphysema and both patients with idiopathic pulmonary fibro sis failed to achieve improvement in RV function (mean Delta FAC +2.3/-1.2%). Conclusions. Improvement of RV function assessed by echocardi ography occurs after lung transplantation, even in patients with sever e preoperative RV dysfunction, However, the degree of improvement is v ariable and may depend on the degree of RV afterload reduction and the presence or absence of intrinsic myocardial disease, RV ejection para meters do not distinguish between these two possibilities.