Right Ventricular Failure Following Heart Transplantation-Recovery After Extended Mechanical Support

Yerebakan, Can; Buz, Semih; Huebler, Michael; Weng, Y.; Lehmkuhl, H.; Hetzer, Roland

doi:10.1111/j.1540-8191.2008.00698.x

Cited by 7 publications

(5 citation statements)

References 6 publications

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“…Importantly, RV dysfunction has been linked to severe transplant complications, accounting for over 10% of early deaths after cardiac transplantation . RV dysfunction is also an indicator of early graft rejection and mortality in Htx patients and is associated with increased likelihood of allograft rejection complications …”

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confidence: 99%

“…15 RV dysfunction is also an indicator of early graft rejection and mortality in Htx patients and is associated with increased likelihood of allograft rejection complications. [15][16][17] While myocardial deformation is now routinely measured by conventional echocardiography and is starting to be used for clinical decision-making, several MR tools have also emerged to detect changes in segmental and regional contractility, dyssynchrony, twist, and torsion. Initial studies have shown that these advanced functional parameters are significantly reduced in adult and pediatric Htx recipients compared with controls, and that they may predict development of rejection even in the presence of preserved ejection fraction (EF).…”

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confidence: 99%

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Myocardial velocity, intra‐, and interventricular dyssynchrony evaluated by tissue phase mapping in pediatric heart transplant recipients

Berhane

Ruh

Husain

et al. 2019

Magnetic Resonance Imaging

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Background Endomyocardial biopsy (EMB) is the standard method for detecting allograft rejection in pediatric heart transplants (Htx). As EMB is invasive and carries a risk of complications, there is a need for a noninvasive alternative for allograft monitoring. Purpose To quantify left and right ventricular (LV & RV) peak velocities, velocity twist, and intra‐/interventricular dyssynchrony using tissue phase mapping (TPM) in pediatric Htx compared with controls, and to explore the relationship between global cardiac function parameters and the number of rejection episodes to these velocities and intra‐/interventricular dyssynchrony. Study Type Prospective. Subjects Twenty Htx patients (age: 16.0 ± 3.1 years, 11 males) and 18 age‐ and sex‐matched controls (age: 15.5 ± 4.3 years, nine males). Field Strength/Sequence 5T; 2D balanced cine steady‐state free‐precession (bSSFP), TPM (2D cine phase contrast with three‐directional velocity encoding). Assessment LV and RV circumferential, radial, and long‐axis velocity–time curves, global and segmental peak velocities were measured using TPM. Short‐axis bSSFP images were used to measure global LV and RV function parameters. Statistical Tests A normality test (Lilliefors test) was performed on all data. For comparisons, a t‐test was used for normally distributed data or a Wilcoxon rank‐sum test otherwise. Correlations were determined by a Pearson correlation. Results Htx patients had significantly reduced LV (P < 0.05–0.001) and RV (P < 0.05–0.001) systolic and diastolic global and segmental long‐axis velocities, reduced RV diastolic peak twist (P < 0.01), and presented with higher interventricular dyssynchrony for long‐axis and circumferential motions (P < 0.05–0.001). LV diastolic long‐axis dyssynchrony (r = 0.48, P = 0.03) and RV diastolic peak twist (r = –0.64, P = 0.004) significantly correlated with the total number of rejection episodes. Data Conclusion TPM detected differences in biventricular myocardial velocities in pediatric Htx patients compared with controls and indicated a relationship between Htx myocardial velocities and rejection history. Level of Evidence: 2 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;51:1212–1222.

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confidence: 99%

mentioning

confidence: 99%

Myocardial velocity, intra‐, and interventricular dyssynchrony evaluated by tissue phase mapping in pediatric heart transplant recipients

Berhane

Ruh

Husain

et al. 2019

Magnetic Resonance Imaging

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“…RVADs have been successfully used for the management of RVF in patients with RV infarct, after cardiac surgery, after LVAD implantation, and following heart transplantation [239][240][241][242][243][244]. RVADs will increase pressure but not sufficiently to overcome the increased RV afterload potentially injuring the lung [245].…”

Section: Mechanical Circulatory Supportmentioning

confidence: 99%

Hospital and intensive care unit management of decompensated pulmonary hypertension and right ventricular failure

et al. 2015

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Pulmonary hypertension and concomitant right ventricular failure present a diagnostic and therapeutic challenge in the intensive care unit and have been associated with a high mortality. Significant co-morbidities and hemodynamic instability are often present, and routine critical care unit resuscitation may worsen hemodynamics and limit the chances of survival in patients with an already underlying poor prognosis. Right ventricular failure results from structural or functional processes that limit the right ventricle's ability to maintain adequate cardiac output. It is commonly seen as the result of left heart failure, acute pulmonary embolism, progression or decompensation of pulmonary hypertension, sepsis, acute lung injury, or in the perioperative setting. Prompt recognition of the underlying cause and institution of treatment with a thorough understanding of the elements necessary to optimize preload, cardiac contractility, enhance systemic arterial perfusion, and reduce right ventricular afterload are of paramount importance. Moreover, the emergence of previously uncommon entities in patients with pulmonary hypertension (pregnancy, sepsis, liver disease, etc.) and the availability of modern devices to provide support pose additional challenges that must be addressed with an in-depth knowledge of this disease.

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“…If all of these treatment modalities fail, either right ventricular assist device or ECMO support should be provided and may be required for several days or even weeks. 8 We have preferred the latter treatment modality because many of these patients have concomitant severe hypoxemia.…”

Section: Commentmentioning

confidence: 99%

Immediate Postoperative Care of the Heart Transplant Recipient: Perils and Triumphs

Novick

2009

Semin Cardiothorac Vasc Anesth

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The early postoperative care of a heart transplant recipient remains challenging, even in experienced centers with a long tradition of excellence. Approximately 10% to 20% of heart transplant recipients experience potentially life-threatening right ventricular dysfunction intraoperatively and early postoperatively due to an elevated pulmonary vascular resistance. In addition, heart transplant recipients experience a high risk of perioperative hemorrhage, as well as opportunistic infection and rejection. The authors describe a case of severe right ventricular dysfunction in a 46-year-old male several hours after heart transplantation for a dilated cardiomyopathy. This patient was salvaged by judicious multimodality therapy including the use of adrenergic agents, phosphodiesterase inhibitors, inhaled nitric oxide, and extracorporeal membrane oxygenation. The risk factors for the development of early graft failure after heart transplantation are reviewed, along with the principles of appropriate management of this complication.

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Right Ventricular Failure Following Heart Transplantation-Recovery After Extended Mechanical Support

Cited by 7 publications

References 6 publications

Myocardial velocity, intra‐, and interventricular dyssynchrony evaluated by tissue phase mapping in pediatric heart transplant recipients

Myocardial velocity, intra‐, and interventricular dyssynchrony evaluated by tissue phase mapping in pediatric heart transplant recipients

Hospital and intensive care unit management of decompensated pulmonary hypertension and right ventricular failure

Immediate Postoperative Care of the Heart Transplant Recipient: Perils and Triumphs

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