The Journal of Thoracic and Cardiovascular Surgery, Vol 99, 22-29, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Cardiac innervation after double lung transplantation. Toronto Lung Transplant Group
HJ Schaefers, MB Waxman, GA Patterson, AE Frost, J Maurer and JD Cooper
Division of Thoracic Surgery, Toronto General Hospital, Ontario, Canada.
Double lung transplantation has been successfully introduced for patients
with end-stage pulmonary disease and preserved cardiac function. An
advantage of this operation compared with heart-lung transplantation is
retention of the recipient's heart. The operative dissection, however, may
lead to interruption of sympathetic and parasympathetic pathways to the
heart and consequent denervation of the native heart. The cardiac
innervation of seven double lung transplant recipients was investigated by
the heart rate response to carotid sinus massage, the Valsalva maneuver,
intravenous injection of atropine, and exercise. Five single lung and two
heart-lung transplant recipients were studied for comparison. Of the seven
double lung transplant recipients, three had abnormal responses to carotid
sinus massage, six to the strain phase of the Valsalva maneuver, and five
to the release phase of the Valsalva maneuver. Three of six double lung
transplant recipients tested had no response to intravenous injection of
atropine, and five of seven patients had an abnormal recovery of heart rate
after maximal exercise. No patient had a normal response to all
interventions, and three patients had responses compatible with complete
cardiac denervation. It is concluded that cardiac denervation may occur
after double lung transplantation, most likely caused by surgical
interruption of sympathetic and parasympathetic pathways during dissection
of the recipient's trachea.
