Pulmonary hemodynamics before and after pediatric heart transplantation

Background Pulmonary hypertension (PH) may limit the outcome of pediatric heart transplantation (pHTx). We evaluated pulmonary hemodynamics in children undergoing pHTx. Methods Cross‐sectional, single‐center, observational study analyzing pulmonary hemodynamics in children undergoing pHTx. Results Twenty‐three children (female 15) underwent pHTx at median (IQR) age of 3.9 (.9–8.2) years with a time interval between first clinical signs and pHTx of 1.1 (.4–3.2) years. Indications for pHTx included cardiomyopathy (CMP) (n = 17, 74%), congenital heart disease (CHD) (n = 5, 22%), and intracardiac tumor (n = 1, 4%). Before pHTx, pulmonary hemodynamics included elevated pulmonary artery pressure (PAP) 26 (18.5–30) mmHg, pulmonary capillary wedge pressure (PCWP) 19 (14–21) mmHg, left ventricular enddiastolic pressure (LVEDP) 17 (13–22) mmHg. Transpulmonary pressure gradient (TPG) was 6.5 (3.5–10) mmHg and pulmonary vascular resistance (Rp) 2.65 WU*m2 (1.87–3.19). After pHTx, at immediate evaluation 2 weeks after pHTx PAP decreased to 20.5 (17–24) mmHg, PCWP 14.5 (10.5–18) mmHg (p < .05), LVEDP 16 (12.5–18) mmHg, TPG 6.5 (4–12) mmHg, Rp 1.49 (1.08–2.74) WU*m2 resp.at last invasive follow up 4.0 (1.4–6) years after pHTx, to PAP 19.5 (17–21) mmHg (p < .05), PCWP 13 (10.5–14.5) mmHg (p < .05), LVEDP 13 (10.5–14) mmHg, TPG 7 (5–9.5) mmHg, Rp 1.58 (1.38–2.19) WU*m2 (p < .05). In CHD patients PAP increased (p < .05) after pHTx at immediate evaluation and decreased until last follow‐up (p < .05), while in CMP patients there was a continuous decline of mean PAP values immediately after HTx (p < .05). Conclusions While PH before pHTx is frequent, after pHTx the normalization of PH starts immediately in CMP patients but is delayed in CHD patients.