ABSTRACT
Studies of the lesser circulation hemodynamics in 150 patients with dilatation cardiomyopathy and in 15 after heart transplantation revealed secondary postcapillary pulmonary hypertension of more than 60 mm Hg in cases with dilatation cardiomyopathy with systolic pressure in the pulmonary artery (SPPA) in 30% of patients, transpulmonary gradient (TPG) of more than 15 mm Hg and pulmonary vascular resistance (PVR) or more than 4 Wood's U in 15.3% of patients. Two stages of pulmonary hypertension in dilatation cardiomyopathy should be singled out: I with SPPA of 60 mm Hg, TPG of 15 mm Hg, and PVR of less than 4 Wood's U, and II with SPPA of more than 60 mm Hg, TPG of more than 15 mm Hg, and PVR of more than 4 Wood's U. Orthotopic transplantation of the heart is indicated for patients with Stage I pulmonary hypertension. For patients with Stage II condition prolonged inotropic and vasodilator therapy is necessary, and if it fails, heterotopic transplantation of the heart or transplantation of the heart and lungs should be resorted to. The basic characteristics of the lesser circulation reflecting the reversibility of pulmonary circulation disorders are SPPA, TPG, and PVR. Failure of prolonged inotropic vasodilator therapy may be indicative of irreversible injury to pulmonary vessels. Lesser circulation hemodynamics usually normalizes a month after heart transplantation. If TPG is less than 15 mm Hg and PVR less than 2 Wood's U, the incidence of reversible posttransplantation right-ventricular insufficiency depends on SPPA pretransplantation level. Mortality because of right-ventricular insufficiency was 8.33%. One-year survival after heart transplantation is related to preoperative TPG and PVR values.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Cardiomyopathy, Dilated/physiopathology , Heart Transplantation/physiology , Pulmonary Circulation , Adolescent , Adult , Cardiac Catheterization , Cardiomyopathy, Dilated/complications , Cardiomyopathy, Dilated/mortality , Cardiomyopathy, Dilated/therapy , Combined Modality Therapy , Female , Hemodynamics/drug effects , Humans , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/mortality , Hypertension, Pulmonary/physiopathology , Hypertension, Pulmonary/therapy , Male , Middle Aged , Pulmonary Circulation/drug effects , Time Factors , Vasodilator Agents/therapeutic useABSTRACT
From October, 1986 to February, 1990 eighty-five potential donors with death of the brain were examined at the Scientific Research Institute of Transplantology and Artificial Organs, USSR Ministry of Public Health. Thirty of them were used as heart donors in orthotopic transplantation of the heart; 24 (80%) were males and 6 (20%) females. The cause of death of the brain was craniocerebral trauma in 13, brain tumor in 9, hemorrhage into the brain tissue in 7 cases, and gunshot injury to the skull with damage to the brain in one case. In appraisal of the donors; in 8 (26.7%) cases the ECG did not differ from the initial one, in another 8 cases (26.7%) the ECG demonstrated electrolyte disorders in the form of hypokalemia , still in another 8 cases right bundle-branch block was encountered, in 2 (6.65%) the ECG showed transient form of cardiac fibrillation, in still another 2 cases I-II degree atrioventricular block was found, in one (3.3%) right and left bundle-branch block was demonstrated, and in one case the ECG showed diminished nutrition in the region of the posterior left-ventricular wall. All donors had disorders of homeostasis characteristic of patients with death of the brain, while the condition of hemodynamics conformed to these disorders. It is concluded on the basis of the obtained data that electrocardiographic monitoring is expedient and that it plays a role in complex appraisal of a potential heart donor.
