Pulmonary hypertension - intra- and early postoperative management in patients undergoing lung transplantation.
BACKGROUND
Single lung transplantation, bilateral lung transplantation and combined heart-lung transplantation are the procedures currently being performed in patients with arterial pulmonary hypertension and pulmonary hypertension as a result of end-stage lung disease. In patients with severe pulmonary hypertension, regardless of its aetiology, general anaesthesia and mechanical ventilation could precipitate the onset of cardiac failure and the necessity of extracorporeal circulation employment.


OBJECTIVE
To assess the clinical and prognostic value of the pulmonary artery pressure (PAP) measured during the intra- and early postoperative period in patients undergoing lung transplantation.


METHODS
We analysed 20 patients undergoing lung transplantation in the Silesian Centre for Heart Disease in Zabrze, of whom 13 suffered from pulmonary hypertension before the operation. The PAP was measured using Swan-Ganz catheters.


RESULTS
Pulmonary artery pressure markedly decreased after transplantation (systolic, diastolic and mean PAP values were 31/19/23 mmHg, respectively) but in 3 recipients the mean PAP exceeded 25 mmHg (45/23/30 mmHg). In all 3 cases a cardiopulmonary bypass was required and single-lung transplantation was performed. Pulmonary hypertension immediately after the operation was the potential marker of lung dysfunction (pulmonary oedema, ischaemia-reperfusion injury, infection) - all 3 patients with increased PAP developed complications.


CONCLUSIONS
Lung transplantation is associated with a significant reduction in pulmonary artery pressures immediately after graft implantation. The persistence of pulmonary hypertension in the early postoperative period suggests temporal allograft dysfunction and affects the post-operative outcome.
Kucewicz-Czech
Ewa
E
Department of Cardiology, Medical University of Silesia, Silesia Center for Heart Diseases, Zabrze, Poland. kardanest@sum.edu.pl
Wojarski
Jacek
J
Zegleń
Sławomir
S
Przybylski
Roman
R
Zembala
Marian
M
Głowacki
Jan
J
Saucha
Wojciech
W
Goliszek
Leszek
L
Szafron
Bartłomiej
B
Maruszewski
Marcin
M
Czyzewski
Damian
D
D000328:Adult; D005112:Extracorporeal Circulation; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000601:surgery*; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011182:Postoperative Care / Q000379:methods*; D011379:Prognosis; D011669:Pulmonary Wedge Pressure