ТРАНСПЛАНТАЦИЯ СЕРДЦА У ПАЦИЕНТКИ С ПОСТТРАВМАТИЧЕСКОЙ АНЕВРИЗМОЙ ЛЕГОЧНОЙ АРТЕРИИ

Right heart catheterization (RHC) should be performed on all candidates in preparation for listing for cardiac transplantation. Patient, 64 y. o., with chronic heart failure NYHA III class, had developed a rare complication while performing that procedure – a rupture of segmental branch of pulmonary artery (PA) with pulmonary haemorrhage. The episode of pulmonary bleeding was stopped conservatively without surgical management. There was a pseudoaneurysm formation of segmental branch of PA 2,7 × 2,8 cm with signs of thrombosis. Afterfi ve months the patient underwent heart transplantation without severe complications in perioperative period. No more recurrent episodes of pulmonary haemorrhage were identifi ed.Обязательной процедурой, выполняемой перед включением кандидата на трансплантацию сердца в лист ожидания, является катетеризация правых отделов сердца и легочной артерии (ЛА). У пациентки 64 летс хронической сердечной недостаточностью III функционального класса по NYHA при выполнении данной манипуляции возникло редкое осложнение – разрыв сегментарной ветви ЛА с развитием легочного кровотечения. На фоне комплексной интенсивной терапии эпизод легочного кровотечения был купирован, не потребовав хирургического лечения. Сформировалась ложная аневризма сегментарной ветви ЛА размерами 2,7 × 2,8 см с признаками тромбирования. Спустя пять месяцев пациентка перенесла трансплантацию сердца, периоперационный период протекал без развития тяжелых осложнений, повторных эпизодов легочного кровотечения зафиксировано не было

On the possibility to increase sensitivity of diagnostic tests for fixed pulmonary hypertension in heart transplant candidates

Background: Fixed pulmonary hypertension (PH) in heart transplant candidates is a risk factor for right ventricular failure in the postoperative period and early mortality. Patients with fixed PH are not included in the waiting list. Thus, the correct assessment of the pulmonary circulation before the operation affects both clinical management and prognosis. Aim: To reduce the risk of incorrect patient non-inclusion to the waiting list by reduction of false negative test results for PH reversibility.Materials and methods: Fourteen heart transplant candidates were included in this retrospective cohort single center study. Fixed PH with pulmonary vascular resistance (PVR) exceeding 3.5 Wood's units was found in all these patients using right heart catheterization and pulmonary vasoreactivity tests. Initially, these patients had not been put into the waiting list. Pulmonary catheterization was performed in the intensive care unit with a Swan-Ganz catheter and pre-pulmonary thermodilution technique. To perform pulmonary vasoreactivity tests, inhaled iloprost (n = 12) or nitric oxide (n = 2) were used. Subsequently all patients received levosimendan infusion at a dose of 12.5 (0.05–0.2) mg/kg/min, with repeated pulmonary artery catheterization and pulmonary vasoreactivity tests at 72 hours after the infusion. Pulmonary vasoreactivity tests results allowed 13 patients to be included into the waiting list. Heart transplantation was performed in 8 recipients, with postoperative assessment of their hemodynamic and clinical parameters. Data are presented as median [25th percentile; 75th percentile].Results: After the levosimendan infusion, there was a decrease in the pulmonary artery mean pressure from 45 [36; 47] to 29.5 [23; 37] mm Hg (p < 0.01), and in PVR from 6.9 [4.9; 8.9] to 3.6 [2.9; 5.9] Wood's units (p <0.01). In 7 patients, PVR decreased to less than 3.5 Wood's units: the rest of the patients underwent pulmonary vasoreactivity tests. As a result, 13 of 14 patients showed reversible PH and were included into the waiting list. By the date of the manuscript submission, heart transplantation has been performed in 8 patients. Their PVR 6 hours after surgery was 2.2 [2; 3.1] Wood's units; there were no cases of fixed PH and right heart failure. There was a single death associated to a hemorrhagic stroke at day 6 after heart transplantation. The sensitivity of pre-operative pulmonary vasoreactivity tests with the use of levosimendan was 87.5%.Conclusion: Levosimendan infusion may increase the sensitivity of the pulmonary vasoreactivity tests before patients' inclusion into the waiting list for heart transplantation

COMPARISON OF HEMODYNAMIC EFFECTS OF INHALATORY ILOPROST AND NITRIC OXIDE IN PATIENTS WITH SEVERE LEFT VENTRICLE DYSFUNCTION

Aim. To compare the effect of nitric oxide (NO) and inhalatory iloprost (IIP) on the hemodynamics of pulmonary hypertension patients, associated with severe systolic dysfunction of the left ventricle (LV).Material and methods. A retrospective description research performed, of the results of 158 consequently done tests for reversibility of pulmonary hypertension with NO and IIP in 124 candidates for cardiac transplantation, with pulmonary vascular resistance (PVR) more than 2,5 units of Wood. Totally, 32 females and 92 males investigated (mean age 48,9±11,2 y. o.) with heart failure (HF) of ischemic (n=59) and non-coronary (n=65) origin, with the LF ejection fraction 22,5±5,2%. Inhalation of NO in 80 ppm concentration was applied in 47 cases (39 patients), IIP with dosage 20 mcg — in 111 cases (93 patients). Pressure measurement in pulmonary artery (PA) and hemodynamics parameters was done with Swan-Ganz catheter. The data presented as the mean ± standard deviation.Results. Decrease of the mean pressure in PA was noted: at NO from 34,7±8,4 to 32,7±9,7 mmHg (p=0,015), IIP from 36,7±10 to 31,1±9,2 mmHg (p<0,001). Pulmonary resistance decreased at NO from 4,8±1,7 to 3,6±1,6 Wood units (p<0,001) and IIP — from 4,9±2 to 3,1±1,4 Wood units (p<0,001). With NO, total peripheral vascular resistance (TPVR) and blood pressure (BP) did not change, but IIP decreased TPVR from 1772±495 to 1445±444 dyn·sec·cm-5 (p<0,001) and BPav from 79,7±10 to 74,8±11,5 mmHg (p<0,001). NO caused mild overload on the LV: PA wedge pressure increased from 19,6±6,5 to 21,2±7,9 mmHg (p=0,038), contrary, IIP decreased wedge pressure from 20,2±6,5 to 18,7±6,6 mmHg (p<0,001). Increase of preand postload at NO inhalation led to decrease of the stroke volume index (SVI) from 23,8±7,9 to 22,4±6,3 mL/m2 (p=0,023). And IIP increased SVI from 26,2±7,2 to 30,7±8,7 mL/m2 (p<0,001).Conclusion. In patients with severe systolic dysfunction of the LV, IIP (contrary to NO) positively influenced the injured LV

HEART TRANSPLANTATION IN PATIENT WITH POST-RUPTURE PSEUDOANEURYSM OF SEGMENTAL BRANCH OF PULMONARY ARTERY

Right heart catheterization (RHC) should be performed on all candidates in preparation for listing for cardiac transplantation. Patient, 64 y. o., with chronic heart failure NYHA III class, had developed a rare complication while performing that procedure – a rupture of segmental branch of pulmonary artery (PA) with pulmonary haemorrhage. The episode of pulmonary bleeding was stopped conservatively without surgical management. There was a pseudoaneurysm formation of segmental branch of PA 2,7 × 2,8 cm with signs of thrombosis. Afterfi ve months the patient underwent heart transplantation without severe complications in perioperative period. No more recurrent episodes of pulmonary haemorrhage were identifi ed