Bundgaard H, Boesgaard S, Mortensen S A, Arendrup H, Aldershvile J
Medical Department B, Rigshospitalet, Copenhagen, Denmark.
Scand Cardiovasc J. 1997;31(6):339-42. doi: 10.3109/14017439709075950.
Acute right ventricular failure due to persistent pulmonary hypertension is a risk factor for premature death after cardiac transplantation. The purpose of this study was to follow changes in pulmonary haemodynamics in patients with pulmonary hypertension undergoing heart transplantation, and to examine whether postoperative changes can be predicted from a preoperative nitroglycerin (NTG) challenge. Seventeen consecutive patients with NYHA class IV heart failure and pulmonary hypertension (pulmonal vascular resistance (PVR) > 2.5 Wood units) underwent an NTG infusion before cardiac transplantation and were followed up using measurements of pulmonary haemodynamics before, early (24 h) and late (6 months) after cardiac transplantation. The effect of NTG was measured preoperatively and compared with posttransplantation values. Postoperative (24 h) PVR was reduced in all patients when compared with preoperative findings (PVR from 4.1 +/- 0.2 to 1.9 +/- 0.2 Wood units, Mean +/- SEM, p < 0.05). Mean pulmonary artery pressure (mPAP) was lowered in 16 of out 17 patients (41 +/- 2 to 26 +/- 1 mmHg, p < 0.05). None of the parameters were significantly changed during the subsequent 6 months. Postoperative PVR and mPAP were accurately estimated by preoperative NTG infusion (NTG vs 24 h posttranspl: PVR 2.2 +/- 0.2 vs 1.9 +/- 0.2 Wood units, p > 0.05; mPAP 30 +/- 2 vs 26 +/- 1 mmHg, p > 0.05). Heart transplantation candidates with pulmonary hypertension responsive to NTG can be expected to obtain a postoperative immediate fall in pulmonary pressures and PVR. The magnitude of this circulatory improvement can be predicted from a preoperative NTG infusion and is not different from values measured 6 months after transplantation.
持续性肺动脉高压所致的急性右心室衰竭是心脏移植术后过早死亡的一个危险因素。本研究的目的是追踪接受心脏移植的肺动脉高压患者的肺血流动力学变化，并探讨术前硝酸甘油（NTG）激发试验能否预测术后变化。17例连续的纽约心脏协会（NYHA）IV级心力衰竭且伴有肺动脉高压（肺血管阻力（PVR）>2.5伍德单位）的患者在心脏移植前接受了NTG输注，并在心脏移植前、术后早期（24小时）和晚期（6个月）通过测量肺血流动力学进行随访。术前测量NTG的效应并与移植后的值进行比较。与术前结果相比，所有患者术后（24小时）的PVR均降低（PVR从4.1±0.2降至1.9±0.2伍德单位，均值±标准误，p<0.05）。17例患者中有16例的平均肺动脉压（mPAP）降低（从41±2降至26±1 mmHg，p<0.05）。在随后的6个月中，所有参数均无显著变化。术前NTG输注可准确估计术后PVR和mPAP（NTG与移植后24小时：PVR 2.2±0.2与1.9±0.2伍德单位，p>0.05；mPAP 30±2与26±1 mmHg，p>0.05）。对NTG有反应的肺动脉高压心脏移植候选者术后肺动脉压力和PVR有望立即下降。这种循环改善的程度可通过术前NTG输注来预测，且与移植后6个月测量的值无差异。
