TRANSESOPHAGEAL ECHOCARDIOGRAPHY TO EVALUATE PATIENTS WITH SEVERE PULMONARY-HYPERTENSION FOR LUNG TRANSPLANTATION

The surgical approach to lung transplantation for patients with severe pulmonary hypertension will be dependent on the primary disease and s pecific cardiac anatomy. To determine the safety and utility of transe sophageal echocardiography in the management of patients with severe p ulmonary hypertension who are being evaluated for lung transplantation , we studied 48 consecutive patients, aged 38 +/- 11 years, with pulmo nary artery systolic pressure of 70 mm Hg or greater. All patients pre viously underwent left and right heart catheterization, transthoracic echocardiography, and radionuclide ventriculography. Transesophageal e chocardiography was tolerated well by all patients. Additional data th at significantly altered surgical therapy were found in 12 of 48 patie nts (25%): proximal pulmonary artery thrombi (3), patent foramen ovale with significant right to left shunting (2), atrial septal defect (2) , double-outlet right ventricle (2), ventricular septal defect (2), an d exclusion of atrial septal defect (1). These findings were confirmed surgically in all patients except 3, who died awaiting transplantatio n Transesophageal echocardiography is useful in the evaluation of pati ents with severe pulmonary hypertension.