Gorter Thomas M, Verschuuren Erik A M, van Veldhuisen Dirk J, Hoendermis Elke S, Erasmus Michiel E, Bogaard Harm J, Vonk Noordegraaf Anton, Berger Rolf M F, van Melle Joost P, Willems Tineke P
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Interact Cardiovasc Thorac Surg. 2017 Jun 1;24(6):890-897. doi: 10.1093/icvts/ivx025.
Pulmonary arterial hypertension (PAH) is a progressive and often fatal disease characterized by increased pulmonary vascular resistance (PVR) and right ventricular (RV) failure. End-stage PAH is often an indication for a lung transplant (LTX). Our goal was to study ventricular recovery using cardiac magnetic resonance imaging late after LTX.
We studied 10 patients with PAH who underwent isolated bilateral LTX. RV and left ventricular (LV) volumes, function and mass were measured. In addition, the RV stroke volume/end-systolic ratio (SV/ESV), the LV eccentricity index, the RV/LV volume ratio, the area of the tricuspid valve annulus and the severity of tricuspid regurgitation (TR) were calculated.
The median age was 44 [30-54] years and the mean PVR was 1020 ± 435 dynes·s·cm - 5 . Six patients had ≥ moderate TR. After LTX, the RV ejection fraction increased from 32 to 64% ( P < 0.001) and both RV volume (from 118 to 51 ml/m 2 , P < 0.001) and RV mass (from 69 to 33 g/m 2 , P < 0.001) decreased. The mean SV/ESV ratio increased from 0.5 to 1.9 ( P < 0.001) and the LV mass increased from 55 to 61 g/m 2 ( P = 0.005). There was a decrease in both the LV eccentricity index (from 2.8 to 1.1, P < 0.001) and the RV/LV volume ratio (from 2.3 to 0.8, P < 0.001). The area of the tricuspid valve annulus also decreased (from 9.8 to 4.6 cm 2 /m 2 , P < 0.001); no patient had ≥ mild TR post-LTX.
Cardiac magnetic resonance imaging confirms ventricular recovery after isolated bilateral LTX for end-stage PAH.
肺动脉高压（PAH）是一种进行性且常致命的疾病，其特征为肺血管阻力（PVR）增加和右心室（RV）衰竭。终末期PAH通常是肺移植（LTX）的指征。我们的目标是使用心脏磁共振成像研究LTX术后晚期的心室恢复情况。
我们研究了10例接受孤立性双侧LTX的PAH患者。测量了RV和左心室（LV）的容积、功能和质量。此外，计算了RV每搏输出量/收缩末期容积比值（SV/ESV）、LV偏心指数、RV/LV容积比值、三尖瓣环面积和三尖瓣反流（TR）的严重程度。
中位年龄为44[30 - 54]岁，平均PVR为1020±435达因·秒·厘米⁻⁵。6例患者有≥中度TR。LTX术后，RV射血分数从32%增加到64%（P<0.001），RV容积（从118降至51毫升/平方米，P<0.001）和RV质量（从69降至33克/平方米，P<0.001）均下降。平均SV/ESV比值从0.5增加到1.9（P<0.001），LV质量从55克/平方米增加到61克/平方米（P = 0.005）。LV偏心指数（从2.8降至1.1，P<0.001）和RV/LV容积比值（从2.3降至0.8，P<0.001）均下降。三尖瓣环面积也减小（从9.8降至4.6平方厘米/平方米，P<0.001）；LTX术后无患者有≥轻度TR。
心脏磁共振成像证实终末期PAH患者接受孤立性双侧LTX术后心室恢复。
