EARLY RIGHT VENTRICULAR failure after orthotopic heart transplantation is a common
complication that has profound effects on patient survival and morbidity.
1
It is believed that the vast majority of cases of early post-transplant right ventricular
dysfunction are the result of ischemia-reperfusion injury secondary to warm ischemic
time, ineffective cardioplegia, coronary air embolism, and/or mechanical trauma at
harvest.
2
In addition, unlike the left ventricle, the right ventricle does not tolerate acute
increases in afterload, placing patients with elevated pulmonary vascular resistance
at risk for post-transplant right-heart failure.
3
Rarely, mechanical causes of post-transplant right ventricular dysfunction can be
identified. A case of early post-transplant right ventricular failure secondary to
iatrogenic cor triatriatum is presented. The transesophageal echocardiographic (TEE)
and hemodynamic abnormalities associated with this rare complication are reviewed.Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiothoracic and Vascular AnesthesiaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The registry of the international society for heart and lung transplantation: Fifteenth official report.J Heart Lung Transplantation. 1998; 17: 656-668
- Severe right heart failure after heart transplantation.Transplant Int. 2005; 18: 326-332
- Right ventricular adaptation to increased afterload after orthotopic cardiac transplantation in the setting of recipient chronic pulmonary hypertension.Circulation. 1997; 96: II-141-II-147
- Cor triatriatum in adults: Three new cases and a brief review.Texas Heart Inst J. 1999; 26: 206-210
- Diagnosis and surgical correction of cor triatriatum in an adult: Combined use of transesophageal and contrast echocardiography, and a review of literature.Echocardiography. 2006; 23: 506-509
- Early diagnosis and follow-up by echocardiography of acquired cor triatriatum after orthotopic heart transplantation.J Heart Lung Transplant. 1992; 11: 1073-1077
- Two-dimensional, spectral Doppler, and color flow imaging in adults with acquired and congenital cor triatriatum.Am Soc Echocardiog. 1991; 4: 177-184
- Acquired cor triatriatum after orthotopic cardiac transplantation.Ann Thorac Surg. 1995; 59: 751-753
- Supramitral valve obstruction from hypertrophied native atrial tissue as a complication of orthotopic heart transplantation.J Heart Lung Transplant. 1997; 16: 922-925
- Orthotopic cardiac transplantation technique: A survey of current practice.Ann Thorac Surg. 1999; 68: 1242-1246
- Orthotopic cardiac transplantation: Comparison of outcome using biatrial, bicaval, and total techniques.J Cardiac Surg. 2005; 20: 102-106
- The bicaval anastomosis technique for orthotopic heart transplantation yields better atrial function than the standard technique: an echocardiographic automatic boundary detection study.J Heart Lung Transplant. 1998; 7: 1065-1074
- Right ventricular function early after total or standard orthotopic heart transplantation.Ann Thorac Surg. 1994; 57: 183-187
- Heart transplantation with bicaval and pulmonary venous anastomoses.J Cardiovasc Surg. 1997; 38: 561-566
- Mechanical flow obstruction after heart transplantation diagnosed by TEE.Ann Thorac Surg. 1994; 58: 890-891
- The role of intraoperative transesophageal echocardiography in heart transplantation.Echocardiography. 2002; 19: 599-604
- Standard orthotopic heart transplantation versus total orthotopic heart transplantation.Circulation. 1995; 92: II-196-II-201
- A human cardiac transplant: An interim report of a successful operation performed at Groote Schuur Hospital, Capetown.S Afr Med J. 1967; 41: 1271-1274
- Anesthesia for heart transplant patients.Semin Anesth Perioper Med Pain. 2004; 1: 23-33
- Registry of the international society for heart and lung transplantation: Twenty-fourth official adult heart transplant report—2007.J Heart Lung Transplant. 2007; 26: 769-781
- Assessment of hyperacute rejection in a rat-to-primate cardiac xenograft model.Transplantation. 1996; 9: 1305-1313
- Left ventricular dysfunction after orthotopic cardiac transplantation.in: Emery R.W. Miller L.W. Handbook of Cardiac Transplantation. Lippincott Williams & Wilkins, Philadelphia, PA1996: 129
- Anesthetic management for cardiac transplantation.in: Hensley F.A. Martin D.E. Gravlee G.P. A Practical Approach to Cardiac Anesthesia. (ed 3). Lippincott Williams & Wilkins, Philadelphia, PA2003: 425-447
- UHC Clinical Practice Advancement Center.UHC Services Corporation, Oak Brook, IL1996
- Free radical chemistry of nitric oxide: Looking at the dark side.Chest. 1994; 105: 79S-84S
- Inhaled nitric oxide primes lung macrophages to produce reactive oxygen and nitrogen immediates.Am J Resp Crit Care Med. 1998; 158: 931-938
- Inhaled iloprost in eight heart transplant recipients presenting with post-bypass acute right ventricular dysfunction.Acta Anaesthesiol Scand. 2006; 10: 1213-1217
- Treatment of patients with mildly symptomatic pulmonary arterial hypertension with bosentan (EARLY study): A double-blind, randomised controlled trial.Lancet. 2008; 371: 2093-2100
- Hemodynamic effects of inhaled aerosolized iloprost and inhaled nitric oxide in heart transplant candidates with elevated pulmonary vascular resistance.Eur J Cardiothorac Surg. 2002; 5: 746-752
- Inhaled prostacyclin for treatment of pulmonary hypertension after cardiac surgery or heart transplantation: A pharmacodynamic study.J Cardiothorac Vasc Anesth. 1996; 10: 864-868
- Inhaled nitric oxide versus intravenous vasodilators in severe pulmonary hypertension after cardiac surgery.Anesth Analg. 1999; 89: 1108-1115
- Inhaled nitric oxide for pulmonary hypertension after heart transplantation.Transplantation. 2001; 72: 638-641
- Transesophageal echocardiography during organ transplantation.J Cardiothorac Vasc Anesth. 1998; 12: 686-694
- Cor triatriatum in a 70-year-old woman: Role of transesophageal echocardiography and dynamic three-dimensional echocardiography in diagnostic assessment.J Am Soc Echocardiogr. 1998; 11: 837-840
- A case of cor triatriatum in an eighty-year-old man: Transesophageal echocardiographic observation of multiple defect.J Am Soc Echocardiogr. 1997; 10: 185-188
Article info
Footnotes
Linda Shore-Lesserson, MD
Mark A. Chaney, MD
Section Editors
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
