open access

Vol 67, No 9 (2009)
Other
Published online: 2009-10-12
Submitted: 2012-12-28
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Original article
Pulmonary hypertension – intra- and early postoperative management in patients undergoing lung transplantation

Ewa Kucewicz-Czech, Jacek Wojarski, Sławomir Żegleń, Roman Przybylski, Marian Zembala, Jan Głowacki, Wojciech Saucha, Leszek Goliszek, Bartłomiej Szafron, Marcin Maruszewski, Damian Czyżewski
Kardiol Pol 2009;67(9):989-994.

open access

Vol 67, No 9 (2009)
Other
Published online: 2009-10-12
Submitted: 2012-12-28

Abstract

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.
Aim: 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.

Abstract

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.
Aim: 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.
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Keywords

pulmonary hypertension; lung transplantation; right heart failure

About this article
Title

Original article
Pulmonary hypertension – intra- and early postoperative management in patients undergoing lung transplantation

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 67, No 9 (2009)

Pages

989-994

Published online

2009-10-12

Bibliographic record

Kardiol Pol 2009;67(9):989-994.

Keywords

pulmonary hypertension
lung transplantation
right heart failure

Authors

Ewa Kucewicz-Czech
Jacek Wojarski
Sławomir Żegleń
Roman Przybylski
Marian Zembala
Jan Głowacki
Wojciech Saucha
Leszek Goliszek
Bartłomiej Szafron
Marcin Maruszewski
Damian Czyżewski

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