ISOLATED LUNG TRANSPLANTATION FOR PATIENTS WITH EISENMENGER SYNDROME

Background. Eisenmenger's syndrome remains one of the greatest challen ges in lung transplantation. Methods and Results. Since October 1990, seven such patients with Eisenmenger's syndrome received isolated pulm onary grafts (six double lungs and one single lung). Mean patient age was 32+/-6 years (two men and five women). The preoperative mean pulmo nary arterial pressure was 90.7+/-31.2 mm Hg, and the ventriculoscinti gram showed markedly enlarged right ventricle and normal left ventricu lar function with ejection fraction of 0.660+/-0.115. Three atrial sep tal defects and four patent ducti arteriosus were repaired concomitant ly. Excised lung histology showed plexogenic pulmonary arteriopathy wi th Heath-Edwards' grade 4 through 6. One double lung patient who had p reexisting systemic vascular collapse died intraoperatively. The other six patients tolerated transplantation, and on the first operative da y, mean pulmonary artery pressure decreased to 22.4+/-7.3 mm Hg (P<.00 2) and gas exchange was acceptable with an arterial/alveolar oxygen te nsion ratio of 0.47+/-0.15. Two patients died of mediastinal and pulmo nary infection. The follow-up for the four survivors ranged from 13 to 25 months after transplantation. Conclusions. Our preliminary experie nce shows that concomitant isolated lung transplantation with cardiac repair could be a viable therapeutic option for patients with Eisenmen ger's syndrome and normal left ventricular function. Dynamic right ven tricular outflow obstruction is a potential hemodynamic problem in the se pulmonary recipients.