Single lung transplantation is an effective treatment for patients with severe chronic obstructive pulmonary disease. Pulmonary hyperinflation, which is seen in most patients with severe chronic obstructive pulmonary disease, makes the task of appropriately matching the donor and recipient difficult. It seems that the optimal matching strategy remains undefined. No correlation between donor/recipient size match (actual and predicted) and the degree of functional improvement after single lung transplantation was found. There were no significant differences noted when comparing the functional outcomes of right and left lung transplant recipients. It was concluded that the chronic hyperinflation associated with severe chronic obstructive pulmonary disease allows for the use of significantly larger donors. The use of expanded donor/recipient size match criteria in patients with severe chronic obstructive pulmonary disease may shorten the waiting period prior to single lung transplantation and provide better utilization of donor organs.
The prognosis for patients with pulmonary hypertension is extremely poor. Predictors of poor prognosis among these patients include a cardiac index less than 2.8 L/m/m2, a mean pulmonary artery pressure higher than 50 mm Hg, a mean right atrial pressure more than 10 mm Hg, and PaO2 less than 70 mm Hg. Balloon atrial septostomy was performed as a palliative procedure in six patients with pulmonary hypertension to limit further deterioration while they awaited lung transplantation. The goal of balloon atrial septostomy was to increase cardiac output while limiting the reduction in systemic oxygen saturation to less than 10% of baseline. This procedure may prove to be a valuable adjunct to reduce morbidity and mortality from right ventricular failure for pulmonary hypertension candidates awaiting lung transplantation.
The prognosis for patients with pulmonary hypertension is extremely poor. Predictors of poor prognosis among these patients include a cardiac index less than 2.8 L/m/m2, a mean pulmonary artery pressure higher than 50 mm Hg, a mean right atrial pressure more than 10 mm Hg, and PaO2 less than 70 mm Hg. Balloon atrial septostomy was performed as a palliative procedure in six patients with pulmonary hypertension to limit further deterioration while they awaited lung transplantation. The goal of balloon atrial septostomy was to increase cardiac output while limiting the reduction in systemic oxygen saturation to less than 10% of baseline. This procedure may proven to be a valuable adjunct to reduce morbidity and mortality from right ventricular failure for pulmonary hypertension candidates awaiting lung transplantation.
Transmyocardial revascularization (TMR) surgery is a palliative and investigative surgical procedure with the goal of increasing the quality of life for patients with intractable angina pectoris who are unsuitable for percutaneous transluminal coronary angioplasty or coronary artery bypass graft surgery. It improves myocardial perfusion and oxygen supply to the left ventricle, thus decreasing the frequency and intensity of anginal episodes. Many patients continue to have episodes of angina post-operatively but the frequency of those episodes should decrease. TMR may be a good treatment option for otherwise untreatable patients who live with severe, debilitating angina.
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