对患有肺静脉高压的心脏移植候选者吸入伊洛前列素后肺血管反应的评估。

Evaluation of pulmonary vascular response to inhaled iloprost in heart transplant candidates with pulmonary venous hypertension.

作者信息

Braun S, Schrötter H, Schmeisser A, Strasser R H

机构信息

Technical University Dresden, Department of Medicine/Cardiology, Germany.

出版信息

Int J Cardiol. 2007 Jan 31;115(1):67-72. doi: 10.1016/j.ijcard.2006.01.067. Epub 2006 Jun 23.

DOI:10.1016/j.ijcard.2006.01.067

PMID:16797747

Abstract

OBJECTIVE

Chronic left-heart failure is often associated with the development of pulmonary venous hypertension. In heart transplant candidates this is of great significance because the healthy donor heart has to compensate the increased right-ventricular afterload. Right-ventricular dysfunction is still responsible for 19% of all early deaths after orthotopic heart transplantation. Careful preoperative assessment of pulmonary vascular resistance by right-heart catheterization is essential. Reversibility testing is generally carried out to clarify therapeutic options for the post-transplant period. The objective of this case series is to report our institutional experience with inhaled iloprost compared to the common used oxygen/nitroglycerin method for reversibility testing.

METHODS

Right-heart catheterization was performed in 23 patients with severely impaired left-ventricular function (EF < or = 25%, pVO2 < or = 14 ml/kg/min, NYHA III or IV) with combined pulmonary venous hypertension (TPG > 12 mm Hg and or PVR > 250 dyn x s x cm(-5)). An intraindividual comparison was performed between of the hemodynamic effect with oxygen/nitroglycerin s.l. and inhaled iloprost.

RESULTS

The transpulmonary gradient fell significantly from an initial 16 mm Hg to 13 mm Hg on oxygen/nitroglycerin s.l. compared to 10 mm Hg on inhaled iloprost. Pulmonary vascular resistance fell significantly from an initial 344 dyn x s x cm(-5) to 270 dyn x s x cm(-5) on oxygen/nitroglycerin s.l. compared to 209 dyn x s x cm(-5) on inhaled iloprost. On inhaled iloprost a moderate systemic effect was noticed.

CONCLUSION

In heart transplant candidates with pulmonary venous hypertension reversibility testing with inhalation of iloprost is a save method and significantly more effective than the combination of inhaled oxygen plus nitroglycerin s.l.

摘要

目的

慢性左心衰竭常与肺静脉高压的发生相关。在心脏移植候选者中，这具有重要意义，因为健康的供体心脏必须代偿增加的右心室后负荷。右心室功能障碍仍是原位心脏移植后所有早期死亡的19%的原因。通过右心导管术对肺血管阻力进行仔细的术前评估至关重要。通常进行可逆性测试以明确移植后期的治疗选择。本病例系列的目的是报告我们机构使用吸入伊洛前列素与常用的氧气/硝酸甘油方法进行可逆性测试的经验。

方法

对23例左心室功能严重受损（射血分数≤25%，每搏量≤14 ml/kg/min，纽约心脏协会心功能分级III级或IV级）且合并肺静脉高压（跨肺压差>12 mmHg和/或肺血管阻力>250 dyn·s·cm⁻⁵）的患者进行右心导管检查。对舌下含服氧气/硝酸甘油和吸入伊洛前列素的血流动力学效应进行个体内比较。

结果

舌下含服氧气/硝酸甘油时，跨肺压差从初始的16 mmHg显著降至13 mmHg，而吸入伊洛前列素时为10 mmHg。舌下含服氧气/硝酸甘油时，肺血管阻力从初始的344 dyn·s·cm⁻⁵显著降至270 dyn·s·cm⁻⁵，而吸入伊洛前列素时为209 dyn·s·cm⁻⁵。吸入伊洛前列素时观察到中度的全身效应。