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Delayed right heart failure following lung transplantation
P M Kirshbom1, V F Tapson, J K Harrison
1Division of General and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA.
Chest
|February 1, 1996
Summary
Delayed right ventricular outflow tract obstruction (RVOTO) can cause severe heart failure after lung transplantation. This case highlights the importance of considering late-onset RVOTO in heart failure diagnosis post-transplant.
Area of Science:
- Cardiology
- Thoracic Surgery
- Transplantation Medicine
Background:
- Dynamic right ventricular outflow tract obstruction (RVOTO) is a known complication post-lung transplantation, often linked to inotropic agents.
- Pulmonary hypertension is a common indication for lung transplantation.
Observation:
- A patient developed severe, delayed right-sided heart failure more than two months after sequential bilateral lung transplantation and ventricular septal defect closure.
- Initial post-transplant evaluation showed no evidence of outflow tract obstruction.
Findings:
- Cardiac catheterization revealed dynamic RVOTO and elevated right ventricular end-diastolic pressure.
- Treatment with metoprolol tartrate and diltiazem hydrochloride successfully resolved the RVOTO and heart failure.
Implications:
- This case underscores that RVOTO can manifest late after lung transplantation.
- Late-onset RVOTO should be considered in the differential diagnosis for right-sided heart failure in lung transplant recipients.