19 Jun

Assessment of Left Ventricular Diastolic Function After Single Lung Transplantation in Patients With Severe Pulmonary Hypertension: Results

Assessment of Left Ventricular Diastolic Function After Single Lung Transplantation in Patients With Severe Pulmonary Hypertension: ResultsClinical and Doppler Echocardiographic Features
In the patient group, there were eight female patients and one male patient with mean age of 32 years (range, 15 to 48 years). Six patients were diagnosed as having primary pulmonary hypertension and the other three were diagnosed as having secondary pulmonary hypertension due to ventricular septal defect, atrial septal defect, and pulmonary vasculitis from systemic lupus erythematosus, respectively. Five patients received a left lung transplant and four received a right lung transplant. canadian health and care mall

Doppler echocardiography demonstrated marked
right atrial and ventricular dilation with severe tricuspid regurgitation in eight of nine patients before the operation. Right ventricular systolic pressure was significantly elevated with a mean value of 90 mm Hg (range, 73 to 110 mm Hg). From mid-short axis view, the distorted left ventricular shape was observed throughout systole and diastole in all study patients with a mean CSA of 0.63±0.09 (p<0.01, compared with that in control subjects). Left ventricular filling was characterized by a diminished early filling (E: 32±6 cm/s; Ei: 2.8±1.0 cm; both p<0.01) and an enhanced atrial contribution to total filling (atrial filling fraction: 0.64±0.1, p<0.01). Finally, left ventricular isovolumic relaxation time was substantially prolonged with a mean value of 127 ± 14 ms (p<0.01) (Table 1).
Early Changes After Lung Transplantation
All patients manifested dramatic decreases in right ventricular systolic pressure (from mean of 90 to 34, p<0.05), right ventricular size (from mean annulus diameter of 5.4 to 3.7, p<0.05), and severity of tricuspid regurgitation (trivial or mild in all patients) early (<3 months) after lung transplantation (Table 1). The dramatic improvement in left ventricular geometry was also documented in all patients by a significant increase in CSF (mean CSF of 0.63 to 0.88, p<0.05). Interestingly, the impaired early left ventricular filling (AFF 0.61±0.1 vs 0.64±0.1, p=not significant [NS]) and isovolumic relaxation time (115 ±16 vs 127±14, p = NS) did not significantly change compared with preoperative measure -ments, despite dramatic alterations in left ventricular geometry following lung transplantation.
Table 1—Changes in Doppler Echocardiographic Variables Before and After Single Lung Transplantation

Control Group Patient Group
Pre-TX Early (3 mo) Late (12 mo) p Value
HR, beats/min 80 ±13 87±15 89±12 81 ± 12 NS
RVSP, mm Hg 90 ±12 34 ± 11 f 32±8{ <0.01
RVd, cm 3.1±0.3§ 5.4±0.811 3.7±0.5f 3.8±0.8J <0.01
E, cm/s 78±8 32 ±611 44±8 70±12} <0.01
A, cm/s 58 ±8 52±12 61±10 58 ±8 NS
E/A 1.4±0.5 0.6±0.111 0.7±0.2 1.4±0.6j <0.01
Ei, cm 10.4±0.6 2.8±1.011 4.0±1.0 9.6±3.0| <0.01
Ai, cm 5.6 ±1.3 4.4±1.4 5.5±1.9 5.4±3.0 NS
AFF 0.37±0.1 0.64 ±0.1 0.61±0.1 0.35±0.1| <0.01
IVRT, ms 76±7§ 127±14 115 ±16 91±8| <0.01
CSF 0.90±0.2 0.63±0.9 0.88±0.5f 0.87±0.8J <0.01

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