Normal cardiac function in severe chronic lung disease – an important parameter in achieving lung transplantation

Introduction: Structural and/or functional lung disease frequently leads to the appearance of pulmonary heart disease – cor pulmonale (CP). In 10 – 15% of cases of CP, the etiology is represented by pulmonary fibrosis. The curative treatment of this pathology is lung transplantation. Patients require complex assessment of cardiac function to establish pre- and postoperative prognosis and to establish the possible need for heartlung transplantation. Methods: We present the case of a patient aged 45 years, with complex pulmonary pathology, proposed for lung transplantation, who was hospitalized in order to investigate the cardiac function. Physical examination revealed a patient with dyspnea at rest, perioronazal cyanosis, telangiectatic facies, finger clubbing, emphisematous torax, pulmonary crackels, Sat O2%: 85% without oxygen, with no pathological findings on the cardio-vascular examination. Complex pulmonary investigations, which established the current diagnosis and the need for lung transplantation, are: plethysmography, spirometry, bronchoscopy with bronchoalveolar lavage with cytology and bronchial aspirate BK, chest CT native. Sarcoidosis and scleroderma were excluded by specific tests. Results: Biological samples: nonspecific inflammatory syndrome, BNP value: 18 pg/ml. CXR: specific changes in lung pathology and a normal heart. ECG: sinus bradycardia, 55/min., no elements suggestive of impaired right heart. Transthoracic echocardiography: no cardiac involvement secondary to pulmonary disease. Catheterization performed in the right and left heart: no pathological elements. Coronary angiography: normal. Patient’s diagnosis: idiopathic pulmonary fibrosis. Bilateral bronchiectasis. Moderately restrictive ventilatory dysfunction. Severe chronic respiratory insufficiency. Mild mitral regurgitation. Mild tricuspid regurgitation. Heart failure class A ACC/AHA. Conclusions: The peculiarity of the case lies in the total lack of cardiovascular damage in a patient with a long term, rare and severe pulmonary pathology, with present indication for lung transplantation. Normal cardiac function exclusively determines the need for lung transplantation and not for heart-lung transplantation, being also a favorable prognostic factor in the patient’s evolution.

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