Late pulmonary haemodynamic changes in heart-lung transplantation.
As survival improves following heart-lung transplantation (HLT) the importance of obliterative bronchiolitis (OB) as a cause of late death increases. Whilst coronary occlusive disease (COD) may be less common in heart-lung transplant recipients than in patients receiving heart transplants, COD associated with OB can be lethal. We have studied 22 long-term survivors of heart-lung transplantation at an average of 25 months following transplantation during rest and at 50 W supine exercise and with prostacyclin induced vasodilation. Cardiac index increased less with exercise as the physiological measurement of OB using forced expiratory volume in one second (FEV1) fell (P = 0.018). Although resting pulmonary vascular resistance increased with falling FEV1, this increase was still within the normal range. We conclude that a fall in cardiac reserve on exercise accompanies the fall in FEV1 which characterizes OB and may reflect cardiac vascular disease.
Scott
J P
JP
Transplant Unit, Papworth Hospital, Papworth Everard, Cambridge, U.K.
Otulana
B A
BA
Mullins
P A
PA
Aravoj
D J
DJ
Higenbottam
T
T
Wallwork
J
J
D000328:Adult; D001989:Bronchiolitis Obliterans / Q000175:diagnosis / Q000503:physiopathology*; D002302:Cardiac Output / Q000502:physiology; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology*; D006084:Graft Rejection / Q000502:physiology; D016041:Heart-Lung Transplantation / Q000502:physiology*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology*; D011652:Pulmonary Circulation / Q000502:physiology*; D012307:Risk Factors; D014109:Total Lung Capacity / Q000502:physiology
D010100:Oxygen