Wierzbicki Karol, Przybyłowski Piotr, Sobczyk Dorota, Konstanty Janusz, Kapelak Bogusław, Drwiła Rafał, Krochin Marek, Podolec Piotr, Wójcik Sławomir, Marek Grzegorz, Wróbel Krzysztof, Piatek Jacek, Rudziński Paweł, Sadowski Jerzy
Departament of Cardiovascular Surgery and Transplantology, Collegium Medicum of Jagiellonian University, Kraków, Poland.
Przegl Lek. 2006;63(12):1263-8.
Pulmonary hypertension (PH) with pulmonary vascular resistance (PVR) 320-480 ARU resistant to therapy is a contraindication for orthotopic heart transplantation (HTX).
evaluation of pulmonary hypertension in candidates for heart transplantation.
44 patients (pts) with dilated cardiomyopathy (Group I) and 34 patients with ischemic heart disease (Group II) were assessed. Evaluation of PH was done according to the following protocol: 1st measurement (cardiac catheterization): PVR (pulmonary vascular resistance) > or = 320 ARU--infusion of NTG (nitroglycerine) 1 microg/kg/min. (during 10 min.), 2nd measurement: PVR > or = 320 ARU--infusion of NTG 2 microg/kg/min. (during 10 min.), 3rd measurement: final PVR evaluation. If PVR was less than 320 ARU in 2nd or 3rd measurement, the reversibility of PH was diagnosed, and when PVR > or = 320 ARU was observed in 3rd measurement, fixed PH was diagnosed.
No significant difference in baseline PVR between the groups was observed (Group I--332,7 ARU and Group II--327.6 ARU). In 23 patients with PVR > or = 320 ARU reduction of mean values of PVR, MPAP (mean pulmonary artery pressure) and TPG (transpulmonary gradient) was seen (p < 0.001), significantly more prominent in 11 pts from Group I. There was no correlation between duration of the disease and degree of PH. HTX was performed in 25 patients. PVR at 72 hours after HTX was similar in 7 pts with reversible PH and 18 pts with PVR < 320 ARU in 1st measurement.
肺血管阻力（PVR）为320 - 480 ARU且对治疗耐药的肺动脉高压（PH）是原位心脏移植（HTX）的禁忌证。
评估心脏移植候选者的肺动脉高压情况。
评估了44例扩张型心肌病患者（I组）和34例缺血性心脏病患者（II组）。根据以下方案评估PH：首次测量（心导管检查）：PVR（肺血管阻力）≥320 ARU——输注硝酸甘油（NTG）1微克/千克/分钟（持续10分钟）；第二次测量：PVR≥320 ARU——输注NTG 2微克/千克/分钟（持续10分钟）；第三次测量：最终PVR评估。如果在第二次或第三次测量中PVR小于320 ARU，则诊断为PH可逆；如果在第三次测量中观察到PVR≥320 ARU，则诊断为固定性PH。
两组之间的基线PVR无显著差异（I组——332.7 ARU，II组——327.6 ARU）。在23例PVR≥320 ARU的患者中，观察到PVR、平均肺动脉压（MPAP）和跨肺压梯度（TPG）的平均值降低（p < 0.001），在I组的11例患者中更为显著。疾病持续时间与PH程度之间无相关性。25例患者接受了HTX。7例PH可逆患者和18例首次测量时PVR < 320 ARU的患者在HTX后72小时的PVR相似。
