Right-to-left shunt through a patent foramen ovale left open in the management of acute right heart failure after heart transplantation
ABSTRACT Severe pulmonary hypertension is a risk factor for mortality in heart transplantation due to elevated post-operative right heart failure. Various treatment modalities have been used in the management of pulmonary hypertension in the peri-operative period. We report a case of successful management of acute right heart failure after orthotopic heart transplantation by decompression of the right ventricle through the patent foramen ovale of the donor heart and inhalation of iloprost.
- SourceAvailable from: Mykola Tsapenko
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- "With growing experience, procedure-related death rates have been reduced to 5.4%, and the most suitable patient group has been identifi ed among patients with a mean right atrial pressure between 10 and 20 mm Hg (Klepetko et al 2004). Acute right heart failure after orthotopic heart transplantation was successfully managed by decompression of the RV through the patent foramen ovale of the donor heart and inhalation of iloprost (Ozdogan et al 2008). Both pericardiectomy and creation of atrial septal defects have been used in extreme cases of acute RV failure secondary to acute MI (Reynolds and Hochman, 2008). "
ABSTRACT: Pulmonary artery pressure elevation complicates the course of many complex disorders treated in a noncardiac intensive care unit. Acute pulmonary hypertension, however, remains underdiagnosed and its treatment frequently begins only after serious complications have developed. Significant pathophysiologic differences between acute and chronic pulmonary hypertension make current classification and treatment recommendations for chronic pulmonary hypertension barely applicable to acute pulmonary hypertension. In order to clarify the terminology of acute pulmonary hypertension and distinguish it from chronic pulmonary hypertension, we provide a classification of acute pulmonary hypertension according to underlying pathophysiologic mechanisms, clinical features, natural history, and response to treatment. Based on available data, therapy of acute arterial pulmonary hypertension should generally be aimed at acutely relieving right ventricular (RV) pressure overload and preventing RV dysfunction. Cases of severe acute pulmonary hypertension complicated by RV failure and systemic arterial hypotension are real clinical challenges requiring tight hemodynamic monitoring and aggressive treatment including combinations of pulmonary vasodilators, inotropic agents and systemic arterial vasoconstrictors. The choice of vasopressor and inotropes in patients with acute pulmonary hypertension should take into consideration their effects on vascular resistance and cardiac output when used alone or in combinations with other agents, and must be individualized based on patient response.Vascular Health and Risk Management 02/2008; 4(5):1043-60.
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ABSTRACT: The successful delivery of optimal peri-operative care to pediatric heart transplant recipients is a vital determinant of their overall outcomes. The practitioner caring for these patients must be familiar with and treat multiple simultaneous issues in a patient who may have been critically ill preoperatively. In addition to the complexities involved in treating any child following cardiac surgery, caretakers of newly transplanted patients encounter multiple transplant-specific issues. This chapter details peri-operative management strategies, frequently encountered early morbidities, initiation of immunosuppression including induction, and short-term outcomes.Current Cardiology Reviews 05/2011; 7(2):110-22. DOI:10.2174/157340311797484286
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ABSTRACT: Acute pulmonary arterial hypertension (PAH), which may complicate the course of many complex disorders, is always underdiagnosed and its treatment frequently begins only after serious complications have developed. Acute PAH is distinctive because they differ in their clinical presentation, diagnostic findings, and response to treatment from chronic PAH. The acute PAH may take either the form of acute onset of chronic PAH or acute PAH or surgery-related PAH. Significant pathophysiologic differences existed between acute and chronic PAH. Therapy of acute PAH should generally be aimed at acutely relieving right ventricular (RV) pressure overload and preventing RV dysfunction. There are three classes of drugs targeting the correction of abnormalities in endothelial dysfunction, which have been approved recently for the treatment of PAH: (1) prostanoids; (2) endothelin receptor antagonists; and (3) phosphodiesterase-5 inhibitors. The efficacy and safety of these compounds have been confirmed in uncontrolled studies in patients with PAH. Intravenous epoprostenol is suggested to serve as the first-line treatment for the most severe patients. In the other situations, the first-line therapy may include bosentan, sildenafil, or a prostacyclin analogue. Recent advances in the management of PAH have markedly improved prognosis.Cardiovascular Therapeutics 06/2011; 29(3):153-75. DOI:10.1111/j.1755-5922.2009.00095.x · 2.36 Impact Factor