Multidetector computed tomography shows reverse cardiac remodeling after double lung transplantation for pulmonary hypertension

OBJECTIVE

To use multidetector computed tomography (MDCT) to evaluate the structural changes in the right heart and pulmonary arteries that occur in patients with severe pulmonary hypertension treated by double lung transplantation.

MATERIAL AND METHODS

This was a retrospective study of 21 consecutive patients diagnosed with severe pulmonary hypertension who underwent double lung transplantation at our center between 2010 and 2014. We analyzed the last MDCT study done before lung transplantation and the first MDCT study done after lung transplantation. We recorded the following variables: diameter of the pulmonary artery trunk, ratio of the diameter of the pulmonary artery trunk to the diameter of the ascending aorta, diameter of the right ventricle, ratio of the diameter of the left ventricle to the diameter of the right ventricle, and eccentricity index. Statistical analysis consisted of the comparison of the means of the variables recorded.

RESULTS

In all cases analyzed, the MDCT study done a mean of 24±14 days after double lung transplantation showed a significant reduction in the size of the right heart chambers, with improved indices of ventricular interdependency index, and reduction in the size of the pulmonary artery trunk (p<0.001 for all the variables analyzed).

CONCLUSION

Patients with pulmonary hypertension treated by double lung transplantation present early reverse remodeling of the changes in the structures of the right heart and pulmonary arterial tree. MDCT is useful for detecting these changes.

Rapamycin in lung transplantation

INTRODUCTION

Rapamycin (RAPA) is a powerful immunosuppressant that also acts as an antiproliferative, which, therefore, could be useful in the treatment and prevention of bronchiolitis obliterans (BOS) in lung transplant recipients. We sought to report our experiences with RAPA in lung transplant patients with BOS that has not responded to the administration of other drugs.

MATERIALS AND METHODS

We performed a retrospective analysis of the clinical characteristics, pulmonary function, and complications among patients with BOS who received RAPA.

RESULTS

RAPA was administered to 11 patients, three single-lung transplant and eight bilateral lung transplant recipients, of whom five were women and six men, of mean age 48 years (26 to 65). The median posttransplant time to the initiation of RAPA for progressive BOS was 32 months (4 to 69) with a posttreatment follow-up of 15 months (3 to 34). RAPA was administered to all patients in association with a calcineurin inhibitor (tacrolimus in seven cases, and cyclosporine in four and steroids. Eight of the 11 patients (72%) with progressive deterioration of pulmonary function showed improved and/or stabilized FEV1 figures after introduction of RAPA. Eight patients developed adverse effects, which were possibly related to RAPA, leading to treatment withdrawal in two cases. The most frequent adverse effects were infections among 6 of the 12 cases, and myelosuppression in three.

CONCLUSIONS

RAPA may be useful to stabilize or improve pulmonary function in patients with BOS. Nevertheless, it was necessary for patients to be closely monitored so that possible adverse effects, and especially infections, may be detected early.

[Mediastinal dumbbell angiolipoma]

Dumbbell tumors are extremely rare. Most are neurogenic in origin. Growth is both inside and outside the spinal canal, and symptoms debut with medullary or spinal compression. References to non-neurogenic dumbbell tumors are uncommon. This report describes the case of a 56 year-old woman with a dumbbell angiolipoma having mediastinal and spinal cord portions. The tumor was successfully resected using a two-stage procedure. First, the spinal portion was resected using a posterior neurosurgical approach, with improvement of symptoms. Then, the mediastinal portion was removed thoracoscopically.