TIME COURSE OF RESOLUTION OF PULMONARY-HYPERTENSION AND RIGHT VENTRICULAR REMODELING AFTER ORTHOTOPIC CARDIAC TRANSPLANTATION
TIME COURSE OF RESOLUTION OF PULMONARY-HYPERTENSION AND RIGHT VENTRICULAR REMODELING AFTER ORTHOTOPIC CARDIAC TRANSPLANTATION
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DOI：
10.1161/01.cir.76.4.819
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发表时间：
1987-10-01
期刊：
影响因子：
37.8
通讯作者：
SUTTON, MGS
中科院分区：
文献类型：
--
作者：
BHATIA, SJS;KIRSHENBAUM, JM;SUTTON, MGS
大多数严重充血性心力衰竭患者伴有继发性肺动脉高压（PHT）。肺血管阻力（PVR）升高至大于480达因。秒数cm-5（6 Wood单位）是目前原位心脏移植的主要血流动力学禁忌症。我们对24例原位心脏移植受者（21例男性，14-58岁）进行了系列二维多普勒超声心动图检查和右心导管插入术，以确定PHT消退的时间过程和供体右心室的伴随重塑。右心和左心充盈压平行下降，并在移植手术后2周达到上限和正常范围，并在1年随访时保持不变。平均肺动脉压（mm Hg）从38 . ±.术前9至22 .+-。2周时为5，为19 ±-。移植术后1年5例。手术后1年，PVR从202 ± 0.01下降到202 ± 0.01。 89 dynes. cntdot.秒数cm-5至99 . ±. 36 dynes. cntdot.秒数cm-5（p <0.001），而心输出量从3.7 . ±. 1.2至6.3 .+-。1.5升/分钟（p <0.001）。超声心动图分析显示，移植受者术后第1天右心室扩大，大多数存在容量超负荷收缩模式和三尖瓣返流。1年随访时，右心室大小的增加得到维持，而三尖瓣反流的发生率下降。我们的结论是，心脏移植术后肺动脉压力中度升高的问题可以迅速解决。供体右心室对受体肺循环动力学异常的反应是早期扩张和三尖瓣返流，尽管PHT已消退，但仍持续存在。
Most patients with severe congestive heart failure have secondary pulmonary hypertension (PHT). Elevation of pulmonary vascular resistance (PVR) to greater than 480 dynes .cntdot. sec .cntdot. cm-5 (6 Wood units) is currently the principle hemodynamic contraindication to orthotopic cardiac transplantation. We performed serial two-dimensional Doppler echocardiographic examinations and right heart catheterizations in 24 recipients (21 men, 14-58 years old) of orthotopic cardiac transplants to determine the time course of resolution of PHT and the concomitant remodeling of the donor right ventricle. Right and left heart filling pressures declined in parallel and reached the upper and normal range at 2 weeks after the transplant procedure and remained unchanged at 1 year follow-up. Mean pulmonary arterial pressure (mm Hg) decreased from 38 .+-. 9 preoperatively to 22 .+-. 5 at 2 weeks and was 19 .+-. 5 at 1 year after the transplantation procedure. At 1 year after surgery, PVR had decreased from 202 .+-. 89 dynes .cntdot. sec .cntdot. cm-5 preoperatively to 99 .+-. 36 dynes .cntdot. sec .cntdot. cm-5 (p < .001), while cardiac output increased from 3.7 .+-. 1.2 to 6.3 .+-. 1.5 liters/min (p < .001). Echocardiographic analysis showed that transplant recipients had an enlarged right ventricle on day 1 after surgery, and a volume overload contraction pattern and tricuspid regurgitation was present in the majority. This increase in right ventricular size was maintained at 1 year follow-up while the incidence of tricuspid regurgitation decreased. We conclude that there is rapid resolution of moderately elevated pulmonary arterial pressures after cardiac transplantation. The donor right ventricle responds to the abnormal recipient pulmonary circulatory dynamics by developing early dilatation and tricuspid regurgitation that persists despite resolution of PHT.