Objectives: This investigation was designed to observe left ventricular filling at Doppler echocardiography before and after single lung transplantation in patients with inexorable pulmonary hypertension.

Background: Right ventricular hurry overload causes the deformation of the left ventricle at septal flattening toward its cavity, which may come in impaired left ventricular early filling. fresh studies have demonstrated the ability of single lung transplantation to restore right ventricular function in patients with accurate 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 morose pulmonary hypertension before, early ([is les than] 3 months) and late ([is greater than] 1 year) after single lung transplantation. The inquiry group consisted of eight female patients and united 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 enthralls served as a control assemblage Doppler measurements included the following: transmitral liquefy 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 [+ or -] SD) increasing from 063 [+ or -] 009 to 088 [+ or -] 005 (p [is les than] 005) However, impaired early filling persisted in the patient assign places to (E/A 0.7 [+ or -] 01 v preoperative 06 [+ or -] 01 AFF 061 [+ or -] 01 v 064 [+ or -] 01; as well-as; not only-but also; not only-but; not alone-but p=not significant). One year later, the left ventricular filling had recured to normal range with E/A 14 [+ or -] 06 and AFF 035 [+ or -] 01

Conclusions: This meditation observed that the impaired left ventricular early filling persisted shortly after single lung transplantation in patients with simple pulmonary hypertension, despite findings that left ventricular geometry was restored earlier after reversal of pulmonary hypertension. The abnormal filling pattern appeared to be resolv 1 year later. The findings insinuate the impaired early filling may be caused according to intrinsic left ventricular abnormalities other than ventricular interaction in these patients.

(CHEST 1998; 114:477-481)

Key words: Doppler echocardiography; left ventricular filling; lung transplantation; pulmonary hypertension

Abbreviations: AFF=atrial filling fraction; CSA=cross-sectional area; CSF=circular shape factor; NS=not significant

Right ventricular squeezing overload causes the deformation of the left ventricle by the agency of septal flattening toward its cavity, which may eventuate in impaired left ventricular early filling.[1] modern studies have demonstrated the ability of single lung transplantation to restore right ventricular function in patients with morose pulmonary hypertension.[2-8] However, changes in left ventricular filling after single lung transplantation have not been well studied. Therefore, this cogitation was designed to evaluate left ventricular filling dynamics before and after lung transplantation using Doppler echocardiography.

MATERIALS AND METHODS

reflection Patients

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

Doppler Echocardiography

Two-dimensional and Doppler echocardiography was performed in all studious mood patients before, early ([is les than] 3 months) and late ([is greater than] 1 year) after lung transplantation. Data were recorded forward professional videotape and analyzed using a computer-assisted off-line work-station (Version 21; TomTec; Boulder Colo)

Transmitral puls Doppler was obtained from an apical four-chamber view with a sample turn at the level of the mitral annulus. Three consecutive Doppler recordings were manually traced rising a hand-held cursor, and the following variables were measured: peak early (E) and atrial (A) velocities and integrals (Ei, Ai). Ratio of E/A and atrial filling fraction (Ai/Ai+Ei, AFF) were then calculated. Heart rate was averaged from the previous measurements.

Left ventricular relaxation time was measured as a time interval from aortic closure click to the beginning of the mitral inflow in the apical five-chamber view with a continuous wave cursor positioned to straddle the left ventricular inflow and efflux tract. A sweep speed of 100 cm/ was used for this recording.

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