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Ann Thorac Surg 1995;60:271
© 1995 The Society of Thoracic Surgeons
DR HARVEY I. PASS (Bethesda, MD):
You had the capabilities of doing this early and repetitively. There may be very subtle changes, but in the transplant situation, can the technology be used at all in the early postoperative period to monitor signs of rejection that may translate into early pressure changes with increased load in the right ventricle?
DR FRIST:
In our patient population who underwent lung transplantation for pulmonary hypertension, we have not been able to document changes in right ventricular pressures with acute rejection during the early postoperative period. However, we are now collecting data using cine magnetic resonance imaging (MRI) to detect changes in strain within both the right and left ventricles. This sensitive technique may be useful in the early detection of rejection after both heart and lung transplantation.
DR JOHN P. CLARKE (Virginia Beach, VA):
Have you found other uses for this?
DR FRIST:
The purpose of this study was to demonstrate the usefulness of cine MRI in this population. We are now using the technique to follow the course of all our patients-after lung transplantation, after thromboendarterectomy, and after the repair of congenital heart defects-all with acutely unloaded right ventricles. Cine MRI is proving to be the best technique available to document the natural history of the results of transplantation and to determine ultimately the reversibility of the chronically depressed right ventricle introduced to a low-pressure environment.
DR JOSEPH M. ARCIDI (Cleveland, OH):
Doctor Frist, I enjoyed your presentation and listening to your experience with the use of this technique. The experience at the Washington University lung transplant program in St. Louis would support your findings, and they have used MRI in a similar fashion. I am intrigued that the example you showed was a patient with Eisenmenger's syndrome. I know that a number of groups interested in lung transplantation for pulmonary hypertension have always found these patients with secondary pulmonary hypertension resulting from Eisenmenger's syndrome a difficult group to assess regarding the appropriate time for transplantation. How many of the patients in your series had Eisenmenger's syndrome, and how does your group approach these patients with regard to the timing of transplantation?
DR FRIST:
We now have performed single-lung transplantation in 4 patients with Eisenmenger's syndrome and heart-lung transplantation in 3 patients. The timing issue is similar in both groups of patients, although we tend to recommend single-lung transplantation earlier because we want to unload the right ventricle before it becomes irreversibly damaged and because the 2-year survival in that group is superior.
Related Article
Ann. Thorac. Surg. 1995 60: 268-271.
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