Murali S, Uretsky B F, Armitage J M, Tokarczyk T R, Betschart A R, Kormos R L, Stein K L, Reddy P S, Hardesty R L, Griffith B P
Division of Cardiology, University of Pittsburgh, Pa. 15213.
J Heart Lung Transplant. 1992 Jul-Aug;11(4 Pt 1):716-23.
Patients with chronic heart failure frequently have pulmonary hypertension. Because severe preoperative pulmonary hypertension predicts a poor outcome after orthotopic transplantation, pulmonary vasoreactivity is evaluated frequently in the pretransplantation screening of heart failure patients. We prospectively evaluated the utility of the direct pulmonary vasodilator, prostaglandin E1, and compared it to the nonspecific vasodilators, nitroglycerin and sodium nitroprusside, in the evaluation of pulmonary hypertension in 39 heart transplantation candidates. Prostaglandin E1 significantly lowered pulmonary artery pressure, transpulmonary pressure gradient, and pulmonary vascular resistance. An adequate pulmonary vasodilator response (defined as a decline in transpulmonary pressure gradient to less than 15 mm Hg) occurred in 31 patients (79%). In a subgroup of nine patients also tested with nitroglycerin, greater reductions (p less than 0.01) in both transpulmonary pressure gradient and pulmonary vascular resistance occurred with prostaglandin E1, compared to nitroglycerin. Five of six patients who did not respond to nitroglycerin responded to prostaglandin E1. In another subgroup of 12 patients who were also evaluated with sodium nitroprusside, prostaglandin E1 produced a larger decline (p less than 0.05) in transpulmonary pressure gradient and pulmonary vascular resistance than did sodium nitroprusside. Six of eight patients who did not respond to sodium nitroprusside responded to prostaglandin E1. Based on pulmonary vasodilator response to prostaglandin E1, 27 patients were accepted on the transplantation waiting list, and eight patients underwent orthotopic transplantation. Postoperatively, acute right ventricular failure of the donor heart developed in none of these patients. Significant hemodynamic improvement occurred by 24 hours and persisted through 4 weeks of postoperative follow-up in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)
慢性心力衰竭患者常伴有肺动脉高压。由于术前严重肺动脉高压预示原位心脏移植术后预后不良，因此在心力衰竭患者的移植前筛查中经常评估肺血管反应性。我们前瞻性评估了直接肺血管扩张剂前列腺素E1的效用，并将其与非特异性血管扩张剂硝酸甘油和硝普钠进行比较，以评估39例心脏移植候选者的肺动脉高压情况。前列腺素E1显著降低了肺动脉压、跨肺压梯度和肺血管阻力。31例患者（79%）出现了足够的肺血管扩张剂反应（定义为跨肺压梯度降至小于15 mmHg）。在一组也接受硝酸甘油测试的9例患者亚组中，与硝酸甘油相比，前列腺素E1使跨肺压梯度和肺血管阻力的降低幅度更大（p<0.01）。6例对硝酸甘油无反应的患者中有5例对前列腺素E1有反应。在另一组也接受硝普钠评估的12例患者亚组中，前列腺素E1使跨肺压梯度和肺血管阻力的下降幅度比硝普钠更大（p<0.05）。8例对硝普钠无反应的患者中有6例对前列腺素E1有反应。基于对前列腺素E1的肺血管扩张剂反应，27例患者被列入移植等待名单，8例患者接受了原位心脏移植。术后，这些患者均未发生供体心脏急性右心室衰竭。所有患者在术后24小时出现显著的血流动力学改善，并在术后4周的随访中持续存在。（摘要截短至250字）
