Is fixed severe pulmonary hypertension still a contraindication to heart transplant in the modern era of mechanical circulatory support? A review.
Pulmonary vascular hypertension (PVH) is a common complication of severe, long-lasting chronic heart failure. It is nowadays well recognized that PVH, nonresponsive to pharmacological approaches, is a risk factor for early and late mortality after heart transplant. Recent evidences in literature highlighted that in these patients chronic unloading with left ventricular assist device resulted in significant reduction of pulmonary vascular resistance, thus ultimately leading them to successful heart transplant. We described the case history of a 47-year-old man with ischemic cardiomyopathy who underwent uncomplicated Berlin Heart Incor implant for severe chronic heart failure and fixed PVH. Chronic unloading determined a rapid and dramatic improvement of PVH, and the patient underwent successful heart transplant after 5 months of mechanical support.
Andrea
Garatti
G
Department of Cardiovascular Disease "E. Malan", Cardiac Surgery Unit, Policlinico S. Donato Hospital, Milan, Italy. agaratti@tiscali.it
Giuseppe
Bruschi
B
Tiziano
Colombo
C
Maria
Frigerio
F
Ettore
Vitali
V
D000959:Antihypertensive Agents / Q000627:therapeutic use; D000075202:Contraindications; D003362:Cost-Benefit Analysis; D004351:Drug Resistance; D006333:Heart Failure / Q000150:complications / Q000191:economics / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016027:Heart Transplantation / Q000191:economics; D006353:Heart-Assist Devices / Q000191:economics; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000191:economics / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome; D016276:Ventricular Function
D000959:Antihypertensive Agents