Pulmonary Hypertension in Pediatric Cardiac Transplant Candidates—Above Traditional Limitations

Objectives: Traditional cut-offs of transpulmonary gradient (TPG) >15 mm Hg and pulmonary vascular resistance index (PVRi) >6 WUxm² have been supplemented by the evaluation of pulmonary vascular reactivity using vasodilators, such as nitric oxide, and the use of the diastolic transpulmonary gradient (DPG; >7 mm Hg) to define the potential risk of post-Tx right ventricular failure. Additionally, temporary unloading of the left ventricle by LVAD support may lower PVRi to an acceptable level. ECMO for early postoperative support and the availability of specific pulmonary vasodilators for long-term support have an impact on survival. However, age and the individual patient's disease, not addressed in cut-off values, have to be considered in risk stratification. As prospective studies are not feasible, the extension of former limitations for HTx in those patients are based on retrospective case series.

Methods: We would like to report on seven patients with extensive PAH, who had a successful HTx with long-term survival.

Result:

Alter	Diagnose	PCWP (mm Hg)	PVRi (WUxm2)	TPG (mm Hg)	DPG (mm Hg)	SAP/PAPs	Reagibel (NO/O2)
9 Monate	AST, EFE	20		32	19	1	–
1.5 Jahre	IAA	22	4	20	7	1.1	+
1.7 J	AST, EFE	18		49			+
3 J	DCMP	33		28	24	1	–
4.5 J	restr. CMP	28	11.6	28	16	1.4	–
10 J	DCMP	31		49	43	0.9	+
16 J	Shone–K.	30	7.2	23	35	1.5	+

Conclusion: Contraindications for pediatric heart transplant patioents with PAH have to be redefined continuously.

Publication History

Article published online:
21 February 2021