Perioperative management of pulmonary hypertension after heart transplantation in childhood.
BACKGROUND
Pulmonary hypertension is responsible for a substantial part of perioperative and postoperative mortality and morbidity after cardiac transplantation. Treatment of right ventricular failure after increased pulmonary vascular resistance is difficult especially in infants and children. Therefore we started a preventive therapy of pulmonary hypertension after cardiac transplantation to avoid right ventricular failure and compared the results with a group of patients with conventional therapy.


METHODS
Group 1 (n = 13), with transplantation from 1988 to 1991, was treated with vasodilators when symptoms of right ventricular failure developed. Group 2 (n = 19) had preventive treatment with prostaglandin E1 (PGE1), the phosphodiesterase-III inhibitor enoximone, and alkalinazation starting during weaning from cardiopulmonary bypass.


RESULTS
Six patients in group 1 died; four of them as the result of right ventricular failure in the immediate postoperative course despite aggressive treatment. In group 2 there were three deaths as the results of rejection (2) and infection (1). None of these patients developed right ventricular failure (p = 0.02). Cold ischemic time, extracorporeal circulation time, and waiting time before transplantation were significantly longer in group 2. Side effects of this preventive therapy were not observed.


CONCLUSIONS
We conclude that prophylactic therapy of pulmonary hypertension with vasodilators in infants and children after heart transplantation is safe and effective in preventing right ventricular failure in the postoperative course.
Bauer
J
J
Department of Pediatric Cardiology, University of Giessen, Germany.
Dapper
F
F
Demirakça
S
S
Knothe
C
C
Thul
J
J
Hagel
K J
KJ
D000468:Alkalies / Q000008:administration & dosage / Q000627:therapeutic use; D000527:Alprostadil / Q000008:administration & dosage / Q000627:therapeutic use; D002303:Cardiac Output, Low / Q000517:prevention & control / Q000628:therapy; D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003080:Cold Temperature; D004280:Dobutamine / Q000008:administration & dosage / Q000627:therapeutic use; D017335:Enoximone / Q000008:administration & dosage / Q000627:therapeutic use; D005112:Extracorporeal Circulation; D006084:Graft Rejection / Q000209:etiology; D016027:Heart Transplantation; D006801:Humans; D006976:Hypertension, Pulmonary / Q000517:prevention & control*; D007223:Infant; D007430:Intraoperative Care; D009894:Opportunistic Infections / Q000209:etiology; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D011183:Postoperative Complications; D011651:Pulmonary Artery / Q000503:physiopathology; D015996:Survival Rate; D013997:Time Factors; D014655:Vascular Resistance / Q000502:physiology; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018497:Ventricular Dysfunction, Right / Q000517:prevention & control / Q000628:therapy
D000468:Alkalies; D002316:Cardiotonic Agents; D010726:Phosphodiesterase Inhibitors; D014665:Vasodilator Agents; D004280:Dobutamine; D017335:Enoximone; D000527:Alprostadil