HEART-TRANSPLANTATION IN PATIENTS WITH SEVERE PULMONARY-HYPERTENSION AND INCREASED PULMONARY VASCULAR-RESISTANCE

Irreversibly increased pulmonary vascular resistance is a contraindication for cardiac transplantation. At our hospital patients referred for recipient evaluation with systolic pulmonary artery pressure >50 mmHg and pulmonary vascular resistance >2 Wood units (Wu) are tested with intravenous sodium nitroprusside for reversibility. In 23 patients whose increased systolic pulmonary artery pressure (67.4±10.4 mmHg) and resistance (4.8±2.4 Wu) were reduced by nitroprusside, orthotopic heart transplantation was performed without early mortality. Right heart catheterization after transplantation revealed a significant and persistent fall of the elevated pulmonary artery pressure and pulmonary vascular resistance. We conclude that if severe pulmonary hypertension and elevated pulmonary vascular resistance are reversible with nitroprusside, the patient can safely undergo heart transplantation. © 1990 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.