Pre-transplant reversible pulmonary hypertension predicts higher risk for mortality after cardiac transplantation

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

“…Despite the convincing data that PH is an independent risk factor for death, multicenter studies need to identify the specific levels of PVR and GTP above which the risk of death is substantial. The literature addressing a consistent definition for PVR, the various methods of reversibility test, the non-standardization in the periods analyzed after heart transplant has not reached a consensus yet [22,23].…”

“…The PVR reduction usually occurs immediately after transplantation, and it is due to its reversible component [22]. However, there are reports of irreversibility in evolution up to five years in patients with elevated PH, as well as in cases of elevated but yet reversible PVR, a continuous timedependent reduction occurs [23].…”

Tricuspid Valve Insufficiency in Recipients With Transplanted Heart

“…Наличие высокой степени легочной гипертензии у потенциального реципиента является противопоказа-нием к трансплантации сердца из-за следующих пос-ле вмешательства перегрузок давлением и объемом правых отделов сердца [44]. Высокое сосудистое со-противление достаточно быстро приводит к право-желудочковой недостаточности донорского сердца и недостаточности трикуспидального клапана [26,45].…”

Cardiomyocyte and Heart Failure

“…PH and elevated pulmonary vascular resistance (PVR) should be considered as relative contraindications to cardiac transplantation when the PVR is greater than 5 Woods units or the pulmonary vascular index is 6 or the transpulmonary gradient exceeds 16 to 20 mm Hg. If the systolic pulmonary arterial pressure exceeds 60 mmHg in conjunction with any of the aforementioned three variables, the risk of RVF and early death is increased [48]. For those with irreversible pulmonary pressures, a combined heart-lung transplant is a therapeutic choice.…”