J Thorac Cardiovasc Surg 2013;145:e7-e9
© 2013 The American Association for Thoracic Surgery
Acute left ventricular failure after bilateral lung transplantation for idiopathic pulmonary arterial hypertension
Tom Verbelen, MDa,*,
Sophie Van Cromphaut, MD, PhDb,
Filip Rega, MD, PhDa,
Bart Meyns, MD, PhDa
a Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
b Department of Intensive Care, University Hospitals Leuven, Leuven, Belgium
Received for publication July 6, 2012; revisions received September 12, 2012; accepted for publication October 11, 2012.
* Address for reprints: Tom Verbelen, MD, Department of Cardiac Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. (Email: email@example.com).
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We report a case of unexpected severe left ventricular (LV) dysfunction in a patient undergoing a bilateral lung transplant (BLTx). We attribute his complicated postoperative course to diastolic dysfunction in a chronically deprived LV in combination with an increased preload, caused by normalization of the pulmonary vascular resistance (PVR), and an increased afterload during weaning.
After optimal medical treatment for 12 years, a 23-year-old man with idiopathic pulmonary arterial hypertension had deterioration to New York Heart Association functional class III. Catheterization indicated elevated pulmonary arterial pressure (PAP) values of 121 mm Hg systolic, 72 mm Hg diastolic, and 89 mm Hg mean; a severely reduced cardiac index of 1.63 L/(min · m2); and a PVR of 2309 dynes · s · cm–5. In January 2012, the patient underwent an urgent BLTx because of uncontrollable right ventricular failure (Figure 1
, A). Surgery was uneventful. After the operation, PAP decreased to 30 mm systolic, 20 mm diastolic, and 22 mm Hg mean. PVR decreased to . . . [Full Text of this Article]
Copyright © 2013 by The American Association for Thoracic Surgery.