Pulmonary Dysfunction After Lung Transplantation: The Dilemma of Coexisting Mitral Regurgitation

McCartney, Sharon L.; Colin, Brian J.; Davis, Robert D.; Rio, J. Mauricio Del; Swaminathan, Madhav

doi:10.1053/j.jvca.2014.06.017

Cited by 3 publications

(5 citation statements)

References 5 publications

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“…It has been recognised [1,2] that in patients undergoing lung transplantation for pulmonary hypertension, the acute reduction in right ventricular impedence with normalisation of ventricular septal position can unmask a chronically under-preloaded left ventricle, which could precipitate severe acute mitral regurgitation.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, should MR developing in lung transplant patients be managed any differently from that occurring in non-transplant patients? Information on this phenomenon is limited to case reports and small series [1][2][3][4][5]. We sought to review patients developing MR after lung transplantation at our centre so as to clarify these issues.…”

Section: Introductionmentioning

confidence: 99%

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Mitral Valve Regurgitation After Lung Transplantation: Aetiology, Management and Outcome

Shi

Bloom

Shen

et al. 2022

Heart, Lung and Circulation

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BackgroundProblematic mitral regurgitation (MR) may develop following lung transplantation (LTx). There is limited information on the management of MR in LTx patients, as such we sought to evaluate our centre's experience. MethodsFrom 2000 to 2019, 1,054 patients underwent LTx at our centre (896 bilateral, 158 single). We identified patients in whom significant MR developed at any point post-LTx. The aetiology of MR, management and outcome were retrospectively analysed. ResultsEight (8) patients developed severe MR post-LTx, six following bilateral LTx and two following single LTx. Lung transplantation indications included interstitial lung disease (n=5), chronic obstructive pulmonary disease (n=2) and pulmonary arterial hypertension (n=1). Severe MR occurred intraoperatively (n=1), postoperative day 1 (n=1) with the remaining six cases between 80 and 263 days post-LTx. The aetiology was noted to be due to severe left ventricular dysfunction following unmasking of a chronically pulmonary hypertension-related under-preloaded left ventricle in one case, and in the remaining seven patients causes included myxomatous degeneration, ischaemic MR, and functional MR due to annular dilatation. In the patient with intraoperative severe MR, the MR became mild with veno-arterial extra corporeal membrane oxygenation (VA-ECMO) and in the remaining seven patients a variety of procedures were used, including mitral valve repair, valve replacement and transcatheter edge-to-edge mitral valve repair. All patients survived the mitral procedure. Two (2) deaths occurred at 12.9 years (stroke) and 5 years (cancer) from mitral valve surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mitral Valve Regurgitation After Lung Transplantation: Aetiology, Management and Outcome

Shi

Bloom

Shen

et al. 2022

Heart, Lung and Circulation

View full text Add to dashboard Cite

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“…[1][2][3][4] In these reports, prolonged mechanical ventilation or oxygen dependency led to further investigation and unmasking of significant valvular pathology. Recognition of the progression of MR occurred within the first 3 months postoperatively, indicating a unique postoperative phenomenon.…”

Section: Discussionmentioning

confidence: 99%

“…In a previous case report, it was found that worsening of MR could be attributed to a reduction in RV internal dimensions after lung transplantation. 4 The change in RV geometry could have influenced reciprocal changes in the left ventricle, thereby unmasking pre-existing MR and demonstrating a worsening progression postoperatively. However, the results from the current study questioned this hypothesis.…”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, other cases were reported that described new-onset MR that led to respiratory compromise, including a dramatic case of new-onset severe MR that was recognized only after the patient could not be weaned from mechanical ventilation for 42 days after OLT, with successful subsequent extubation on the fifth postoperative day after mitral valve repair. 1,3,4 One hypothesis attributes worsening of MR to a reduction in size of the right ventricle (RV), producing inverse changes in the left ventricle and mitral annulus. 1 According to this hypothesis, the primary lung disease causes pulmonary hypertension, which results in RV dilation and dysfunction.…”

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confidence: 99%

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Mitral Regurgitation After Orthotopic Lung Transplantation: Natural History and Impact on Outcomes

McCartney

Cooter

Samad

et al. 2017

Journal of Cardiothoracic and Vascular Anesthesia

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Objective: Progression of mitral regurgitation (MR) after orthotopic lung transplantation (OLT) may be an underrecognized phenomenon due to the overlapping symptomatology of pulmonary and valvular disease. Literature evaluating the progression of MR after OLT currently is limited to case reports. Therefore, the hypothesis that MR progresses after OLT was tested and the association of preprocedure MR with postoperative mortality was assessed. Design: A retrospective cohort. Setting: A tertiary-care hospital. Participants: Patients who underwent OLT between January 1, 2003 and February 4, 2012. Interventions: After receiving institutional review board approval, a preprocedure transesophageal echocardiogram was compared with a postoperative transthoracic echocardiogram (TTE) to determine the progression of MR. Univariate and multivariate association between preprocedure MR grade and 1-and 5-year mortality was assessed. A p value of o0.05 was considered statistically significant. Measurements and Main Results: From 715 patients who underwent OLT, 352 had a postoperative TTE and were included in the evaluation of progression of MR. Five patients had progression of MR postoperatively, and the mean change in MR score of -0.04 was found to be nonsignificant (p ¼ 0.25). Mortality data were available for 634 of the 715 patients. After covariate adjustment, there was no significant association between MR grade and 1-year mortality (p ¼ 0.20) or 5-year mortality (p ¼ 0.46). Conclusions: This study rejected the hypothesis that primary and secondary MR progresses after OLT and found that preprocedure MR was not associated with increased postoperative mortality. Despite the findings that MR does not progress in all patients, there is a subset of patients for whom MR progression is clinically significant.

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Intraoperative Transesophageal Echocardiography: Monere to Decidere

Montealegre-Gallegos

Mahmood

2014

Journal of Cardiothoracic and Vascular Anesthesia

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Pulmonary Dysfunction After Lung Transplantation: The Dilemma of Coexisting Mitral Regurgitation

Cited by 3 publications

References 5 publications

Mitral Valve Regurgitation After Lung Transplantation: Aetiology, Management and Outcome

Mitral Valve Regurgitation After Lung Transplantation: Aetiology, Management and Outcome

Mitral Regurgitation After Orthotopic Lung Transplantation: Natural History and Impact on Outcomes

Intraoperative Transesophageal Echocardiography: Monere to Decidere

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