Pharmacologic reduction of pretransplantation pulmonary vascular resistance predicts outcome after pediatric heart transplantation.
Pulmonary hypertension leading to donor right ventricular dysfunction remains a major risk factor associated with poor outcome after heart transplantation. This study evaluated a pretransplantation protocol to assess pulmonary vascular resistance index and its response to pharmacologic modulation. Cardiac catheterization was performed in 25 patients (mean age, 8.6 years [range, 1 to 17 years]; mean weight, 27.3 kg [range, 8.1 to 54 kg]) with end-stage heart failure. Mean pulmonary artery and capillary wedge pressures and cardiac index were measured in the baseline state and during administration of 100% oxygen, dobutamine at 10 micrograms/kg/min, and nitroprusside at 1 to 4 micrograms/kg/min. Transpulmonary pressure gradient and pulmonary vascular resistance index were calculated. In 22 survivors, hemodynamics were reassessed 1 and 4 weeks after transplantation. The mean cardiac index significantly increased (2.2 to 3.2 L/min/m2); transpulmonary pressure gradient (12.7 to 9.6 mm Hg) and pulmonary vascular resistance index (6.2 to 3.0 units/m2) decreased during the drug study. In 12 patients with a baseline pulmonary vascular resistance index of more than 6 units/m2, 10 survived heart transplantation. This study shows that pharmacologic reduction of the pulmonary vascular resistance index in the pretransplantation protocol predicts reduced pulmonary vascular resistance index and a favorable outcome after heart transplantation.
Zales
V R
VR
Division of Cardiology, Children's Memorial Hospital, Chicago, IL 60614.
Pahl
E
E
Backer
C L
CL
Crawford
S
S
Mavroudis
C
C
Benson
D W
DW
D000293:Adolescent; D000676:Amrinone / Q000627:therapeutic use; D001794:Blood Pressure; D002302:Cardiac Output; D002648:Child; D002675:Child, Preschool; D004280:Dobutamine / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D016027:Heart Transplantation / Q000009:adverse effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D007223:Infant; D008168:Lung / Q000473:pathology; D009599:Nitroprusside / Q000008:administration & dosage*; D011651:Pulmonary Artery / Q000503:physiopathology*; D011652:Pulmonary Circulation / Q000187:drug effects*; D011669:Pulmonary Wedge Pressure; D014655:Vascular Resistance / Q000187:drug effects*
D009599:Nitroprusside; D004280:Dobutamine; D000676:Amrinone