SUICIDE RIGHT VENTRICLE AFTER LUNG TRANSPLANTATION FOR EISENMENGER SYNDROME

Right ventricular outflow tract obstruction, or ''suicide right ventri cle,'' rarely has been observed after single or bilateral single-lung transplantation for the treatment of Eisenmenger syndrome. We describe our experience in 2 patients with Eisenmenger syndrome in whom right ventricular outflow tract obstruction developed, in 1 after single-lun g transplantation and ventricular septal defect repair and in the othe r after bilateral single-lung transplantation. Both patients suffered progressive deterioration and hemodynamic instability that was unrespo nsive to aggressive medical therapy. Diagnosis was confirmed in both p atients by transesophageal echocardiography. Operative intervention wa s undertaken 72 and 24 hours after transplantation, and consisted of m yectomy and outflow tract patching. One patient survived; the other di ed intraoperatively. The index of suspicion for this problem should be high during the intraoperative performance of transesophageal echocar diography, as well as during direct gradient measurement, with conside ration of immediate management of severe right ventricular outflow tra ct obstruction at the time of transplantation.