Chest
Volume 114, Issue 2, August 1998, Pages 477-481
Journal home page for Chest

Clinical Investigations: Cardiology/Cardiac Surgery
Assessment of Left Ventricular Diastolic Function After Single Lung Transplantation in Patients With Severe Pulmonary Hypertension

https://doi.org/10.1378/chest.114.2.477Get rights and content

Objectives

This study was designed to observe left ventricular filling by Doppler echocardiography before and after single lung transplantation in patients with severe pulmonary hypertension.

Background

Right ventricular pressure overload causes the deformation of the left ventricle by septal flattening toward its cavity, which may result in impaired left ventricular early filling. Recent studies have demonstrated the ability of single lung transplantation to restore right ventricular function in patients with severe pulmonary hypertension. However, changes in left ventricular filling after single lung transplantation have not been well studied.

Methods

We performed Doppler echocardiography in nine patients with severe pulmonary hypertension before, early (<3 months), and late (>1 year) after single lung transplantation. The study group consisted of eight female patients and one male patient with mean age of 32 years (range, 15 to 48 years). Six patients were diagnosed as having primary pulmonary hypertension and three as having secondary pulmonary hypertension. Nine age-matched normal subjects served as a control group. Doppler measurements included the following: transmitral flow early (E) and atrial (A) velocities, integrals (Ei and Ai), and left ventricular isovolumic relaxation time. The ratio of E/A and atrial filling fraction (Ai/Ei+Ai, AFF) were also determined. Left ventricular geometry was assessed from mid-short axis view with a circular shape factor (CSF).

Results

Early after lung transplantation, the left ventricular geometry became more circular with CSF (mean±SD) increasing from 0.63±0.09 to 0.88±0.05 (p<0.05). However, impaired early filling persisted in the patient group (E/A 0.7±0.1 vs preoperative 0.6±0.1, AFF 0.61±0.1 vs 0.64±0.1; both p=not significant). One year later, the left ventricular filling had returned to normal range with E/A 1.4±0.6 and AFF 0.35±0.1.

Conclusions

This study observed that the impaired left ventricular early filling persisted shortly after single lung transplantation in patients with severe pulmonary hypertension, despite findings that left ventricular geometry was restored earlier after reversal of pulmonary hypertension. The abnormal filling pattern appeared to be resolved 1 year later. The findings suggest the impaired early filling may be caused by intrinsic left ventricular abnormalities other than ventricular interaction in these patients.

Section snippets

Study Patients

Between 1991 and 1996, 47 single lung transplantation procedures were performed in 45 consecutive patients at the University of Kentucky Hospital. Clinical diagnoses were severe pulmonary hypertension in 14 patients and end-stage of COPD in the remaining 31. Of the 14 pulmonary hypertension patients, 9 who had complete Doppler echocardiographic examinations preoperatively and postoperatively were selected for this study. Nine age-matched normal subjects served as a control group.

Doppler Echocardiography

Two-dimensional

Clinical and Doppler Echocardiographic Features

In the patient group, there were eight female patients and one male patient with mean age of 32 years (range, 15 to 48 years). Six patients were diagnosed as having primary pulmonary hypertension and the other three were diagnosed as having secondary pulmonary hypertension due to ventricular septal defect, atrial septal defect, and pulmonary vasculitis from systemic lupus erythematosus, respectively. Five patients received a left lung transplant and four received a right lung transplant.

Doppler

Discussion

It is important to restore right ventricular function after single lung transplantation in pulmonary hypertension patients. A number of studies have shown that the right ventricular function improves dramatically immediately after transplantation,2, 3, 4, 5, 6, 7, 8 and the improvement is maintained for at least 2 years.5 Interestingly, our study indicated that the impaired left ventricular early filling persisted early after transplantation, despite the fact that pulmonary hypertension was

Conclusions

This study observed left ventricular filling dynamics by Doppler echocardiography before and after single lung transplantation in patients with severe pulmonary hypertension. The impaired early filling persisted shortly after transplantation, despite restoration of left ventricular geometry after reversal of pulmonary hypertension. The abnormal filling was not resolved until 1 year later. The findings suggest the impaired early filling may be caused by intrinsic left ventricular abnormalities

Cited by (28)

  • Survival and left ventricular dysfunction post lung transplantation for pulmonary arterial hypertension

    2022, Journal of Critical Care
    Citation Excerpt :

    We hypothesize that both chronic adverse remodelling of the left ventricle and withdrawal of mechanical ventilation are contributing etiological factors. Although diastolic dysfunction has predominantly been described in the literature [30,31], we observed systolic dysfunction in 19 patients diagnosed with LVD by echocardiography. In our cohort, diastolic function was not routinely assessed in the postoperative period.

  • Right ventricular assist device in end-stage pulmonary arterial hypertension: Insights from a computational model of the cardiovascular system

    2012, Progress in Cardiovascular Diseases
    Citation Excerpt :

    Such abrupt redistribution of volume can result in pulmonary edema, even in the setting of normal LV systolic and diastolic function.26 In addition, recent studies in animals27,28 and humans29,30 with PAH have provided evidence of LV diastolic dysfunction, manifest as reduced chamber size (i.e., leftward shifted end-diastolic pressure-volume relationship). Indeed, our patient hemodynamic parameter fitting algorithm indicated that with increasing disease severity and progressively lower cardiac outputs, LV diastolic stiffness increased substantially (i.e., higher LV diastolic stiffness coefficient, α, Table 2).

View all citing articles on Scopus

Presented in part at the 46th Annual Scientific Session of the American College of Cardiology, Anaheim, Calif, March 1997.

View full text