Pharmacologic reduction of pretransplantation pulmonary vascular resistance predicts outcome after pediatric heart transplantation. J Heart Lung Transplant 1993;12(6 Pt 1):965-72; discussion 972-3
Date
11/01/1993Pubmed ID
8312321Scopus ID
2-s2.0-0027753001 (requires institutional sign-in at Scopus site) 34 CitationsAbstract
Pulmonary hypertension leading to donor right ventricular dysfunction remains a major risk factor associated with poor outcome after heart transplantation. This study evaluated a pretransplantation protocol to assess pulmonary vascular resistance index and its response to pharmacologic modulation. Cardiac catheterization was performed in 25 patients (mean age, 8.6 years [range, 1 to 17 years]; mean weight, 27.3 kg [range, 8.1 to 54 kg]) with end-stage heart failure. Mean pulmonary artery and capillary wedge pressures and cardiac index were measured in the baseline state and during administration of 100% oxygen, dobutamine at 10 micrograms/kg/min, and nitroprusside at 1 to 4 micrograms/kg/min. Transpulmonary pressure gradient and pulmonary vascular resistance index were calculated. In 22 survivors, hemodynamics were reassessed 1 and 4 weeks after transplantation. The mean cardiac index significantly increased (2.2 to 3.2 L/min/m2); transpulmonary pressure gradient (12.7 to 9.6 mm Hg) and pulmonary vascular resistance index (6.2 to 3.0 units/m2) decreased during the drug study. In 12 patients with a baseline pulmonary vascular resistance index of more than 6 units/m2, 10 survived heart transplantation. This study shows that pharmacologic reduction of the pulmonary vascular resistance index in the pretransplantation protocol predicts reduced pulmonary vascular resistance index and a favorable outcome after heart transplantation.
Author List
Zales VR, Pahl E, Backer CL, Crawford S, Mavroudis C, Benson DW JrMESH terms used to index this publication - Major topics in bold
AdolescentAmrinone
Blood Pressure
Cardiac Output
Child
Child, Preschool
Dobutamine
Drug Therapy, Combination
Heart Transplantation
Humans
Hypertension, Pulmonary
Infant
Lung
Nitroprusside
Pulmonary Artery
Pulmonary Circulation
Pulmonary Wedge Pressure
Vascular Resistance
