Pre-existing Pulmonary Hypertension in Patients With End-stage Heart Failure: Impact on Clinical Outcome and Hemodynamic Follow-up After Orthotopic Heart Transplantation

Teste farmacológico pré-implante na hipertensão pulmonar elevada e fixa em candidatos a transplante heterotópico

“…On the other hand, it is important to know that in many heart transplant programs, patients with these characteristics are referred to the heterotopic technique or even to the heart/lung technique, using the strategy of accepting donors with greater weight and body surface area for patients with reversible or partially reversible elevated PH using the orthotopic technique [24].…”

Left Ventricular Dysfunction With Pulmonary Hypertension

“…However, it is important to note that although lack of reversibility with acute pharmacological interventions may lead to labeling PH as fixed, emerging data have reported delayed reversibility after heart transplantation or LV assist device implantation. 30,31 The potential for delayed reversibility might be considered when candidacy for heart transplantation is evaluated. Although acute reversibility is an important selection criterion for heart transplantation, longer term interventions to reduce PVR could be considered when an acute vasodilator challenge is unsuccessful.…”

Impacto do sildenafil sublingual na hipertensão pulmonar de pacientes com insuficiência cardíaca

“…Pulmonary hypertension (PH) is known to be a poor prognostic factor in patients with Chronic Heart Failure (CHF) [1][2][3][4][5] , increasing the mortality in the early postoperative period of heart transplant (HT) due to right ventricular dysfunction of the transplanted graft [3][4][5][6][7][8][9] . Thus, all patients in the preoperative assessment for HT are routinely submitted to the hemodynamic study of the degree of PH, in order to stratify the risk of this subgroup.…”

“…Depending on the degree of PH diagnosed during the right cardiac catheterization, some patients are submitted to the Vascular Reactivity Test, which evaluates the reversibility of the PH to vasodilators, as the post-HT prognosis of patients with reversible PH is similar to those with no evidence of preoperative pulmonary hypertension [4][5][6][7][8][9] .…”

“…Traditionally, the most frequently used vasodilator is sodium nitroprussiate, a fast-acting, low-cost and easy-to-manage arterial vasodilator, but which has important limitation due to the arterial hypotension it causes 8,10 . This limitation is particularly relevant in these patients, as the systemic systolic arterial pressure of patients with advanced heart failure (HF) is around 90 to 100 mmHg, which, is several situations, limits the applicability of the drug or even carrying out the pulmonary vascular reactivity test.…”