Etiologic diagnosis of pulmonary hypertension through transesophageal echo in candidates to heart-lung transplantation

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Abstract

Background

The primitive etiologic diagnosis of pulmonary hypertension in candidates to heart/lung transplantation is often incorrect or unclear. Transesophageal echo has not widely been tested on this field, then we decided to compare the utility of it versus transthoracic echo in detecting causes of secondary pulmonary hypertension.

Material and method

Twenty one patients (15 female and 6 male, meanage: 41.2 years old) with primary (n =11) and secondary pulmonary hypertension (7 congenital heart diseases and 3 chronic pulmonary embolisms) were prospectively studied by echocardiography, ventilation/perfusion lung scans and hemodinamic study (gold standard). Transesophageal echo correctly identified the cause of 7/10secondary pulmonary hypertension (sensitivity70%, specificity 100%). In five of these 7 cases the primitive diagnosis had been incorrect or unclear(congenital heart diseases undiagnosed).In all (3) cases of chronic pulmonary embolism and in every primary pulmonary hypertension transesophageal echo was not able to define the etiology of pulmonary hypertension. Transthoracic echo correctly detected the cause of 3/10 secondary pulmonary hypertension (sensitivity 30%, specificity100%). Transesophageal versus transthoracic echo in the diagnosis of secondary pulmonary hypertension: p = 0.062. None of 14 anatomic or functional echocardiographic parameters analized was able to differenciate between primary and secondary pulmonary hypertension.

Conclusion

In the small studied population there was an statistical trend suggesting that transesophageal is superior to transthoracic echo in the detection of causes of secondary pulmonary hypertension (particularly congenital heart disease) in candidates to heart/lung transplantation.