Heart and unilateral lung transplantation for end-stage cardiac failure with pulmonary hypertension

心脏和单侧肺移植治疗终末期心力衰竭伴肺动脉高压的有效性在胸内心脏和单侧肺移植模型中进行了评估。作为心力衰竭和肺动脉高压模型，部分结扎自体心脏的右冠状动脉，逐渐结扎对侧肺的肺动脉。所有移植手术均成功进行，对侧结扎使肺血管阻力加倍增加。从超声心动图评价和心室压力-面积关系来看，移植心脏的右心室功能维持良好，并支持了自体心脏衰竭的右心室。在呼吸功能方面，单侧移植肺进行了良好的血气交换，胸部X线检查显示良好的结果。对心脏和肺标本的组织学结果进行了评估，在移植的心脏组织中未观察到缺血或出血性变化。在移植的肺组织中，发现轻度血管周围水肿，但肺泡结构完整。本研究结果提示，心脏和单侧肺移植可能是治疗终末期心力衰竭伴肺动脉高压的首选手术方式之一。

Effectiveness of heart and unilateral lung transplantation for end-stage cardiac failure with pulmonary hypertension was assessed in intrathoracic heart and unilateral lung transplant models of specially-treated dogs without infection. As a model of cardiac failure and pulmonary hypertension, right coronary arteries of the native heart were partly ligated and pulmonary artery of the contralateral lung was gradually ligated. All transplant operations were successfully performed, and pulmonary vascular resistance doubly increased by the contralateral ligation. From echocardiographic evaluation and ventricular pressure-area relationship, right ventricular function of the transplanted heart was well maintained, and it supported the failing right ventricle of the native heart. With respect to respiratory function, unilateral transplanted lung made exellent blood gas exchange and it showed good findings in chest radiographic evaluation. Histopathologic findings of the heart and lung specimens were assessed, and no ischemic or hemorrhagic change was observed in the transplanted heart tissue. In the transplanted lung tissue, mild perivascular edema was recognized, but alveolar structure was intact. These results of this study suggested that heart and unilateral lung transplantation might be one of the procedures of choice for end-stage cardiac failure with pulmonary hypertension.