[Limitations of the feasibility of right catheterization in the evaluation for cardiac transplantation].
The number of patients who survive heart transplantation has considerably increased in recent years, but mortality during the first 3 months still reaches 10 to 20 p. 100 depending on the authors. Among the various causes of death, acute graft deficiency due to pulmonary arterial hypertension plays an important role. In most cases, pulmonary vascular resistance has been misevaluated or its progress has not been foreseen. Between January 1985 and June 1988, 96 heart transplantations were performed at the Broussais Hospital, Paris. We thought that pulmonary vascular resistance could be better evaluated by using dobutamine to mimick transplantation and to assess pulmonary pressure and resistance variations associated with the increase in cardiac output. High doses of dobutamine ranging from 10 to 30 mcg/kg/min were administered to bring the basal cardiac output level up to the theoretical output level or to increase it by 50 p. 100. The 96 patients who had heart transplantation during the aforementioned period were divided into two groups: group I comprised 35 patients who were transplanted before dobutamine was used, while group II comprised 61 patients for whom the dobutamine test was always considered. The mortality rate was 11.75 p. 100 (4/35) in group I and nil in group II as regards death from pulmonary arterial hypertension (p = 0.04). We demonstrate that a single resistance value is not reliable, even when it is normal, when the cardiac output is low. Furthermore, there is no threshold value for contraindication, and indexing resistance alters the scale of values but does not enable normality to be defined. By using the dobutamine test we were able to reduce considerably the mortality due to pulmonary arterial hypertension and also to exclude orthotopic transplantation in some patients.
Dreyfus
G
G
Département de chirurgie cardio-vasculaire, hôpital Broussais, Paris.
Guillemain
R
R
Amrein
C
C
Mihaileanu
S
S
Jebara
V
V
Blanchard
D
D
Carpentier
A
A
D001160:Arterioles; D006328:Cardiac Catheterization; D004280:Dobutamine; D005260:Female; D016027:Heart Transplantation; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000517:prevention & control; D007545:Isoproterenol; D008297:Male; D009599:Nitroprusside; D011183:Postoperative Complications / Q000517:prevention & control*; D011652:Pulmonary Circulation; D011669:Pulmonary Wedge Pressure; D014655:Vascular Resistance
D009599:Nitroprusside; D004280:Dobutamine; D007545:Isoproterenol
Limites de fiabilité du cathétérisme droit lors du bilan pour transplantation cardiaque.