Birsan T, Zuckermann A, Artemiou O, Chevtchik O, Taghavi S, Wolner E, Klepetko W
Abteilung für Herz-Thoraxchirurgie, Universitätsklinik für Chirurgie, AKH, Wien, Osterreich.
Wien Klin Wochenschr. 1998 Jan 30;110(2):45-52.
Pulmonary hypertension (PH) signifies elevated blood pressure in the pulmonary circulation either due to clearly defined causes (cardiac, pulmonary-parenchymatous, systemic) or of idiopathic origin (primary PH, PPH). While conservative treatment is beneficial only for a small number of patients, lung transplantation represents a curative measure. The optimal form of transplantation [i.e. single lung (SLTX), bilateral lung (BLTX) or combined heart-lung transplantation (HLTX)] is still under discussion. This study is a retrospective analysis of 16 patients with different forms of PH who underwent BLTX from 1992 to 1996 in Vienna. Four patients had Eisenmenger's disease due to atrial septum defect, 3 had chronic thromboembolic PH and 9 had PPH. BLTX with cardiopulmonary bypass was the standard procedure in all patients. Acute retransplantation had to be performed in 3 patients. Mean pulmonary arterial pressure was reduced from 63 +/- 11 mmHg preoperatively to 23 +/- 5 mmHg on the second day postoperatively (p < 0.0001), while the cardiac index concomitantly improved from 2.1 +/- 0.5 to 3.9 +/- 1.2 l/min/m2 (p < 0.05). Echocardiography proved normalisation of right ventricular wall thickness and end-diastolic diameter within 12 months, while tricuspid insufficiency, present in all patients before transplantation, resolved completely. Perioperatively 4 patients (25%) died due to septic complications (n = 3) or therapy refractory rejection (n = 1). Follow-up of the remaining patients ranged from 6 to 51 months (mean 33 +/- 17). One patient died at 8 months due to fungal sepsis. Eleven patients (68%) are currently alive. Only 2 of them show functional signs of chronic allograft rejection (bronchiolitis obliterans syndrome). All patients are at present in NYHA functional class I or II. In conclusion, BLTX results in complete recovery of right ventricular function and morphology and offers good functional long-term results. Because SLTX correlates with a high incidence of reperfusion edema, and HLTX is seriously limited by the scarcity of donor organs, BLTX should be the method of choice for treating end stage PH.
肺动脉高压（PH）是指由于明确病因（心脏、肺实质、全身性）或特发性病因（原发性肺动脉高压，PPH）导致的肺循环血压升高。虽然保守治疗仅对少数患者有益，但肺移植是一种治愈性措施。移植的最佳形式[即单肺移植（SLTX）、双侧肺移植（BLTX）或心肺联合移植（HLTX）]仍在讨论中。本研究是对1992年至1996年在维也纳接受BLTX的16例不同形式PH患者的回顾性分析。4例患者因房间隔缺损患有艾森曼格综合征，3例患有慢性血栓栓塞性PH，9例患有PPH。所有患者均采用体外循环下的BLTX作为标准手术。3例患者不得不进行急性再次移植。平均肺动脉压从术前的63±11 mmHg降至术后第二天的23±5 mmHg（p<0.0001），而心脏指数同时从2.1±0.5提高到3.9±1.2 l/min/m2（p<0.05）。超声心动图显示右心室壁厚度和舒张末期直径在12个月内恢复正常，而所有患者移植前存在的三尖瓣关闭不全完全消失。围手术期有4例患者（25%）因败血症并发症（n=3）或治疗难治性排斥反应（n=1）死亡。其余患者的随访时间为6至51个月（平均33±17个月）。1例患者在8个月时因真菌败血症死亡。11例患者（68%）目前存活。其中只有2例表现出慢性移植物排斥反应的功能迹象（闭塞性细支气管炎综合征）。所有患者目前均处于纽约心脏协会（NYHA）心功能I级或II级。总之，BLTX可使右心室功能和形态完全恢复，并提供良好的长期功能结果。由于SLTX与再灌注水肿的高发生率相关，且HLTX受到供体器官稀缺的严重限制，BLTX应成为治疗终末期PH的首选方法。
