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Journal of Artificial Organs

, Volume 16, Issue 2, pp 253–257 | Cite as

A heart transplant candidate with severe pulmonary hypertension and extremely high pulmonary vascular resistance

  • Takuma Sato
  • Osamu SeguchiEmail author
  • Nagisa Morikawa
  • Michinari Hieda
  • Takuya Watanabe
  • Haruki Sunami
  • Yoshihiro Murata
  • Masanobu Yanase
  • Hiroki Hata
  • Tomoyuki Fujita
  • Takeshi Nakatani
Case Report

Abstract

Fixed pulmonary hypertension (PH) is a contraindication for heart transplantation (HTx). Several studies showed that use of a left ventricular assist device (LVAD) in patients with fixed PH who were initially deemed ineligible for HTx effectively decreased pulmonary arterial pressure (PAP), thus permitting HTx. We recently encountered a candidate for HTx who had severe PH with extremely high pulmonary vascular resistance (PVR). A 27-year-old female who had been diagnosed with dilated-phase hypertrophic cardiomyopathy and who was approved for HTx at age 25 was referred to our institute because of severe fatigability with moderate dyspnea even at rest due to severe bilateral heart failure. Despite continuous inotrope infusion, the patient’s symptoms were not relieved. Right heart catheterization (RHC) disclosed a PAP of 62/40 mmHg with severely reduced cardiac output (1.8 l/min). A PVR of 15.9 Wood units suggested progressive worsening of left ventricular function with almost irreversible remodeling of the pulmonary vasculature, and the patient was thought to be contraindicated for HTx. Following 3 weeks of aggressive medical treatment, repeat RHC demonstrated PVR lowering to 8.16 Wood units. This suggested it was likely that PVR could be reversed, and the patient underwent LVAD implantation. RHC performed after LVAD implantation showed a fall in PVR from the initial, extremely high measurement of 15.9 Wood units to 3.4 Wood units at 2 months postoperatively, and to 2.2 Wood units at 1 year. The patient is currently awaiting HTx with favorable LVAD support.

Keywords

Pulmonary hypertension Hemodynamics Heart transplant candidacy Ventricular assist devices Pulmonary vascular resistance 

References

  1. 1.
    Guglin M, Khan H. Pulmonary hypertension in heart failure. J Card Fail. 2010;16:461–74.PubMedCrossRefGoogle Scholar
  2. 2.
    Guazzi M, Borlaug BA. Pulmonary hypertension due to left heart disease. Circulation. 2012;126:975–90.PubMedCrossRefGoogle Scholar
  3. 3.
    Chen JM, Levin HR, Michler RE, Prusmack CJ, Rose EA, Aaronson KD. Reevaluating the significance of pulmonary hypertension before cardiac transplantation: determination of optimal thresholds and quantification of the effect of reversibility on perioperative mortality. J Thorac Cardiovasc Surg. 1997;114:627–34.PubMedCrossRefGoogle Scholar
  4. 4.
    Stehlik J, Edwards LB, Kucheryavaya AY, Benden C, Christie JD, Dipchand AI, Dobbels F, Kirk R, Rahmel AO, Hertz MI. The registry of the international society for heart and lung transplantation: 29th official adult heart transplant report—2012. J Heart Lung Transplant. 2012;31:1052–64.PubMedCrossRefGoogle Scholar
  5. 5.
    Mehra MR, Kobashigawa J, Starling R, Russell S, Uber PA, Parameshwar J, Mohacsi P, Augustine S, Aaronson K, Barr M, Listing Criteria for Heart Transplantation. International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates—2006. J Heart Lung Transplant. 2006;25:1024–42.PubMedCrossRefGoogle Scholar
  6. 6.
    Lejeune P, Leeman M, Deloof T, Naeije R. Pulmonary hemodynamic response to dopamine and dobutamine in hyperoxic and in hypoxic dogs. Anesthesiology. 1987;66:49–54.PubMedCrossRefGoogle Scholar
  7. 7.
    Mentzer RM, Alegre CA, Nolan SP. The effects of dopamine and isoproterenol on the pulmonary circulation. J Thorac Cardiovasc Surg. 1976;71:807–14.PubMedGoogle Scholar
  8. 8.
    Molloy WD, Dobson K, Girling L, Greenberg ID, Prewitt RM. Effects of dopamine on cardiopulmonary function and left ventricular volumes in patients with acute respiratory failure. Am Rev Respir Dis. 1984;130:396–9.PubMedGoogle Scholar
  9. 9.
    Richard C, Ricome JL, Rimailho A, Bottineau G, Auzepy P. Combined hemodynamic effects of dopamine and dobutamine in cardiogenic shock. Circulation. 1983;67:620–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Butler J, Stankewicz MA, Wu J, Chomsky DB, Howser RL, Khadim G, Davis SF, Pierson RN 3rd, Wilson JR. Pre-transplant reversible pulmonary hypertension predicts higher risk for mortality after cardiac transplantation. J Heart Lung Transplant. 2005;24:170–7.PubMedCrossRefGoogle Scholar
  11. 11.
    John R, Liao K, Kamdar F, Eckman P, Boyle A, Colvin-Adams M. Effects on pre- and posttransplant pulmonary hemodynamics in patients with continuous-flow left ventricular assist devices. J Thorac Cardiovasc Surg. 2010;140:447–52.PubMedCrossRefGoogle Scholar
  12. 12.
    Nakatani T, Frazier OH, Lammermeier DE, Macris MP, Radovancevic B. Heterotopic heart transplantation: a reliable option for select group of high-risk patients. J Heart Transplant. 1989;8:40–7.PubMedGoogle Scholar
  13. 13.
    Alba AC, Rao V, Ross HJ, Jensen AS, Sander K, Gustafsson F, Delgado DH. Impact of fixed pulmonary hypertension on post-heart transplant outcomes in bridge-to-transplant patients. J Heart Lung Transplant. 2010;29:1253–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Zimpfer D, Zrunek P, Roethy W, Czerny M, Schima H, Huber L, Grimm M, Rajek A, Wolner E, Wieselthaler G. Left ventricular assist devices decrease fixed pulmonary hypertension in cardiac transplant candidates. J Thorac Cardiovasc Surg. 2007;133:689–95.PubMedCrossRefGoogle Scholar
  15. 15.
    Zimpfer D, Zrunek P, Sandner S, Schima H, Grimm M, Zuckermann A, Wolner E, Wieselthaler G. Post-transplant survival after lowering fixed pulmonary hypertension using left ventricular assist devices. Eur J Cardiothorac Surg. 2007;31:698–702.PubMedCrossRefGoogle Scholar
  16. 16.
    Ochiai Y, McCarthy PM, Smedira NG, Banbury MK, Navia JL, Feng J, Hsu AP, Yeager ML, Buda T, Hoercher KJ, et al. Predictors of severe right ventricular failure after implantable left ventricular assist device insertion: analysis of 245 patients. Circulation. 2002;106:I198–202.PubMedCrossRefGoogle Scholar
  17. 17.
    Fitzpatrick JR 3rd, Frederick JR, Hsu VM, Kozin ED, O’Hara ML, Howell E, Dougherty D, McCormick RC, Laporte CA, Cohen JE, et al. Risk score derived from pre-operative data analysis predicts the need for biventricular mechanical circulatory support. J Heart Lung Transplant. 2008;27:1286–92.PubMedCrossRefGoogle Scholar
  18. 18.
    Matthews JC, Koelling TM, Pagani FD, Aaronson KD, The Right Ventricular Failure Risk Score. A pre-operative tool for assessing the risk of right ventricular failure in left ventricular assist device candidates. J Am Coll Cardiol. 2008;51:2163–72.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society for Artificial Organs 2013

Authors and Affiliations

  • Takuma Sato
    • 1
  • Osamu Seguchi
    • 1
    Email author
  • Nagisa Morikawa
    • 2
  • Michinari Hieda
    • 1
  • Takuya Watanabe
    • 1
  • Haruki Sunami
    • 1
  • Yoshihiro Murata
    • 1
  • Masanobu Yanase
    • 1
  • Hiroki Hata
    • 3
  • Tomoyuki Fujita
    • 3
  • Takeshi Nakatani
    • 1
  1. 1.Division of TransplantationNational Cerebral and Cardiovascular CenterSuitaJapan
  2. 2.Division of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
  3. 3.Division of Adult Cardiac SurgeryNational Cerebral and Cardiovascular CenterSuitaJapan

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