title: Pulmonary vascular remodelling after heart transplantation in patients with cavopulmonary connection.
abstract: OBJECTIVE
  Pulmonary vascular resistance (PVR) after heart transplantation (HT) is an important predictor of postoperative outcomes. We hypothesize that PVR and pulmonary capillary wedge pressure (PCWP) will exhibit favourable pulmonary vascular remodelling in patients with failing cavopulmonary connection (CPC) after HT.
  
  
  METHODS
  Retrospective analysis of patients with superior CPC (SCPC) and total CPC (TCPC) who have undergone HT was performed. Patient data, including age, underlying congenital heart defect, timing of CPC surgery and timing of HT, were reviewed. Right heart catheterization data, including PCWP (mmHg) and PVR indexed (PVRi, Woods Units) from preoperative, at 1 month, 6 months and 12 months after HT, were collected. Paired data were analysed using Student's t-test.
  
  
  RESULTS
  Among 21 patients with failing CPC who underwent HT, 10 had SCPC and 11 had TCPC. Average age at HT was 13.3 ± 8 years. Average time after CPC to HT was 8.5 ± 6.2 years. PVRi was noted to trend down over time after HT (PVRi pre-HT versus 6 months after HT, 2.75 vs 2.06, P = 0.06 and pre-HT versus 12 months after HT, 2.79 vs 2.27, P = 0.09). There was a statistically significant decrease in PCWP at 6 months (pre-HT versus 6 months after HT, 12.6 vs 10.8, P = 0.01) and 12 months (pre-HT versus 12 months after HT, 12.9 vs 10.1, P = 0.01) after HT.
  
  
  CONCLUSIONS
  Pulmonary vascular changes occur gradually after HT in patients with CPC similar to those shown after HT in patients with cardiomyopathy. However, larger studies are needed to investigate correlation between outcomes and the presence or absence of pulmonary vascular changes after HT in CPC patients.
authors.affiliation: Section of Pediatric Cardiac Surgery, Department of Surgery, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, UT, USA Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA aditya.kaza@cardio.chboston.org.
authors.forename: Aditya K
authors.initials: AK
authors.lastname: Kaza
authors.affiliation: Department of Pediatrics, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, UT, USA.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Kaza
authors.affiliation: Division of Pediatric Cardiology, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, UT, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Bullock
authors.affiliation: Division of Pediatric Cardiology, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, UT, USA.
authors.forename: Sheri
authors.initials: S
authors.lastname: Reyna
authors.affiliation: Division of Pediatric Cardiology, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, UT, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Yetman
authors.affiliation: Division of Pediatric Cardiology, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, UT, USA.
authors.forename: Melanie D
authors.initials: MD
authors.lastname: Everitt
mesh_terms: D000293:Adolescent; D000328:Adult; D062186:Arterial Pressure; D002648:Child; D002675:Child, Preschool; D018729:Fontan Procedure / Q000009:adverse effects*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012189:Retrospective Studies; D066253:Vascular Remodeling / Q000502:physiology*; D014655:Vascular Resistance / Q000502:physiology; D055815:Young Adult
keywords: Fontan circulation; Heart transplantation; Single ventricle