Article

Right-to-left Shunt Through a Patent Foramen Ovale Left Open in the Management of Acute Right Heart Failure After Heart Transplantation

Department of Cardiovascular Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation (Impact Factor: 6.65). 02/2008; 27(1):135-7. DOI: 10.1016/j.healun.2007.09.024
Source: PubMed

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. © 2008 International Society for Heart and Lung Transplantation.

0 Followers
 · 
7 Reads
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Feb 2008 · Vascular Health and Risk Management
  • [Show abstract] [Hide abstract]
    ABSTRACT: Pulmonary hypertension is a significant determinant of morbidity and mortality in patients undergoing cardiac surgery. The successful management of these patients requires an individualized and systematic approach. The analysis of preoperative risk factors, perioperative management of hemodynamics, and the prevention and early recognition of postoperative complications is imperative to successfully oversee the care of pulmonary hypertension patients undergoing cardiac surgery.
    No preview · Chapter · Dec 2009
  • Source
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · May 2011 · Current Cardiology Reviews
Show more