title: Left ventricular assist device to avoid heart-lung transplant in an adolescent with dilated cardiomyopathy and severely elevated pulmonary vascular resistance.
abstract: Orthotopic heart transplantation remains the definitive treatment of choice for patients with end-stage heart failure; however, elevated PVRI is a reported risk factor for mortality after heart transplant and, when severely elevated, is considered an absolute contraindication. Use of a ventricular assist device has been proposed as one treatment for reducing pulmonary vascular resistance index in potential heart transplant candidates refractory to medical vasodilator therapies. We report on a teenage patient with dilated cardiomyopathy and severely elevated PVRI, unresponsive to pulmonary vasodilator therapy, who underwent left ventricular assist device implantation to safely allow for aggressive pulmonary vasodilator therapy and to decrease PVRI. The resulting dramatic improvement in PVRI in a relatively short period of time allowed for successful heart transplantation, avoiding the need for heart-lung transplant.
authors.affiliation: Division of Cardiology, Department of Pediatrics, Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. by2190@columbia.edu
authors.forename: Betul
authors.initials: B
authors.lastname: Yilmaz
authors.forename: Warren A
authors.initials: WA
authors.lastname: Zuckerman
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Lee
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Beddows
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Gilmore
authors.forename: Rakesh K
authors.initials: RK
authors.lastname: Singh
authors.forename: Marc E
authors.initials: ME
authors.lastname: Richmond
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Chen
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Addonizio
mesh_terms: D000293:Adolescent; D006328:Cardiac Catheterization / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000628:therapy*; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000628:therapy; D016027:Heart Transplantation / Q000379:methods*; D006353:Heart-Assist Devices; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016040:Lung Transplantation / Q000379:methods; D012307:Risk Factors; D014655:Vascular Resistance
chemical_list: D007166:Immunosuppressive Agents
keywords: adolescent; cardiomyopathy; heart-lung; pediatric heart transplant; pulmonary hypertension