[Hemodynamic study with Swan-Ganz catheterization, concomitant to endomyocardial biopsy in heart transplantation patients. Importance in the early diagnosis of rejection].
OBJECTIVE
To evaluate the role of hemodynamic parameters in the diagnosis of acute rejection who underwent orthotopic cardiac transplantation.


METHODS
A protocol was carried out in 19 patients who underwent heart transplantation and in whom Swan-Ganz hemodynamics was performed immediately prior to routine endomyocardial biopsy in the first few months postoperatively. The results of 28 biopsies were divided in group I--severe rejection who needed pulse-therapy (n = 10) and group II--No or mild/moderate rejection who did not need any pulse (n = 18). Hemodynamic parameters were compared between both groups.


RESULTS
There were significant differences among hemodynamic parameters in groups I and II. Group I had higher mean right atrial pressures (13.0 x 7.3 mmHg), mean pulmonary pressure (26.3 x 20.4 mmHg), mean wedge pressure (14.4 x 10.9 mmHg) and lower cardiac index (2.57 x 3.10 l/min/m2).


CONCLUSIONS
In a routine situation, hemodynamic measurements, as obtained with Swan-Ganz catheter, simultaneously with endomyocardial biopsies, show significant alterations in transplanted patients who develop acute rejection. This information, obtained earlier than the biopsy results, could shorten the time to initiate pulse-therapy in patients with severe rejection.
Almeida
D R
DR
Hospital São Paulo da Escola Paulista de Medicina.
Carvalho
A C
AC
Pessoa
C
C
de Sousa
J A
JA
Branco
J N
JN
Silva
L C
LC
Moura
L
L
Castelo
H J
HJ
Alves
C M
CM
Andrade
J C
JC
D000328:Adult; D001706:Biopsy; D002407:Catheterization, Swan-Ganz; D004699:Endocardium / Q000473:pathology*; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation / Q000473:pathology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011182:Postoperative Care; D013997:Time Factors; D016278:Ventricular Function, Right
Estudo hemodinâmico com cateter de Swan-Ganz, concomitante à biópsia endomiocárdica, em transplantados cardíacos. Importância no diagnóstico precoce da rejeição.