Transient left ventricular failure following bilateral lung transplantation for pulmonary hypertension

Background: Bilateral lung transplantation is an established therapy for en d-stage pulmonary hypertension. Its early postoperative outcome may be bias ed by various complications resulting in unexpected deterioration of the pa tient in terms of hemodynamics and blood gases. Methods: We have reviewed the early postoperative course of patients who un derwent bilateral lung transplantation for pulmonary hypertension at our in stitution and analyzed all available data, especially hemodynamic measureme nts, echocardiographic documentation and therapeutical strategies,in those cases where cardiac dysfunction was found to be responsible for clinical de terioration. Results: Three out of 20 lung transplant recipients operated for pulmonary hypertension experienced severe respiratory insufficiency accompanied by he modynamic decompensation during the first days after surgery. Clinical and laboratory findings together with results of echocardiography and pulmonary artery catheterism helped establish the diagnosis of left ventricular fail ure. This proved to be transitory, but the response to therapy (inotropic d rugs, afterload reduction and eventually prostaglandins) was very variable. Adequately treated, this complication did not preclude the outcome of tran splantation by itself. Conclusion: Left ventricular failure is a possible complication after lung transplantation for pulmonary hypertension. Echocardiography and pulmonary artery catheterism may be useful adjuvant diagnostic tools, beside routine physical examination, chest X-ray, and laboratory analysis. Therapy of this complication must be adapted individually and may be complex.