title: Left Ventricular Dysfunction After Lung Transplantation for Pulmonary Arterial Hypertension.
abstract: BACKGROUND
  Lung transplantation (LT) is the final treatment option for patients with pulmonary arterial hypertension (PAH). Perioperative challenges after LT are unique and commonly include excessive bleeding, arrhythmias, and primary graft dysfunction. Transient left ventricular dysfunction (LVD) is a known postoperative complication, but not fully explored. We describe our experiences at a single institution.
  
  
  METHODS
  We reviewed our database for patients with PAH who underwent LT from July 2008 to July 2012. The data were analyzed for preoperative inotrope use, intravenous prostacyclin, cardiac catheterization, and imaging. Also measured were perioperative ischemic time, bypass time, primary graft dysfunction, ventilator days, length of stay, and mortality. LVD is defined as acute cardiopulmonary compromise (acute worsening of hypoxia with new bilateral infiltrates on imaging) with a drop in LV systolic function of 15% from baseline. We compared data between patients with LVD and without LVD.
  
  
  RESULTS
  Sixteen patients met the criteria, the majority of patients (10) with World Health Organization (WHO) group 1 PAH. Thirteen received intravenous prostacyclin therapy, and 6 required inotropes before surgery. Five patients (31%) developed LVD after transplantation. Average time to onset of LVD was 4.2 days. Preoperative vasopressors were required in 60% of those developing LVD. Patients with LVD had lower right and left ventricular ejection fraction with higher left ventricular end diastolic volume before surgery. All patients recovered from LVD within 4 months after LT.
  
  
  CONCLUSIONS
  LVD is a phenomenon observed mostly in patients with WHO group 1 PAH receiving LT. Prompt recognition and treatment of this condition reduced morbidity.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Texas-Southwestern, Dallas, Texas. Electronic address: sachin.gupta@kp.org.
authors.forename: S
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Texas-Southwestern, Dallas, Texas.
authors.forename: F
authors.initials: F
authors.lastname: Torres
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Texas-Southwestern, Dallas, Texas.
authors.forename: S
authors.initials: S
authors.lastname: Bollineni
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Texas-Southwestern, Dallas, Texas.
authors.forename: M
authors.initials: M
authors.lastname: Mohanka
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Texas-Southwestern, Dallas, Texas.
authors.forename: V
authors.initials: V
authors.lastname: Kaza
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D006328:Cardiac Catheterization; D002316:Cardiotonic Agents / Q000627:therapeutic use; D011464:Epoprostenol / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000601:surgery*; D007902:Length of Stay; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D011300:Preoperative Care / Q000379:methods; D055031:Primary Graft Dysfunction / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000503:physiopathology; D016277:Ventricular Function, Left
chemical_list: D000959:Antihypertensive Agents; D002316:Cardiotonic Agents; D011464:Epoprostenol