Heart transplantation

Heart transplantation is a definitive therapy for patients with advanced heart failure who do not respond to conventional treatments. Right heart catheterization (RHC) is one of the key investigations done during the pre-transplant assessment to evaluate the candidates for transplant. Here is the information on Right Heart Catheterization

🔍What is Right Heart Catheterization(RHC)?

Procedure to introduce a catheter into large veins and right side of heart via right internal jugular or femoral vein to measure pressure and calculate cardiac output.

1. RHC is an essential investigation in patients listed for or referred for heart transplantation for several reasons:

1. 🩺 To evaluate haemodynamics of the recipient heart:

Unlike non-invasive studies like echocardiography or CT scans that give an indirect estimation, Right Heart Catheterisation gives direct measurement of the following:

• Right atrial pressure (RAP)

• Pulmonary artery pressure (PAP)

• Pulmonary capillary wedge pressure (PCWP)

• Cardiac output/index (CO/CI)

• Systemic and Pulmonary vascular resistance

These parameters help classify the patient into types of cardiac failure and also estimate the workload of the heart.

1. 🌬️ To rule out presence of Pulmonary Hypertension(PH):

Irreversible pulmonary hypertension is an absolute contraindication to heart transplantation because the right heart will fail to pump blood against the increased resistance within hours after transplant.

RHC can help in differentiating between left heart failure with secondary pulmonary hypertension and intrinsic pulmonary vascular disease by measuring pulmonary vascular resistance.

If the pulmonary hypertension is reversible with vasodilators/inotropic drugs (as suggested by a positive response to intravenous drugs during the RHC procedure), the patient may be considered for heart transplant.

1. 🔁 To estimate right heart function and decide on need for mechanical circulatory support:

Right heart failure following heart transplant is a dreaded complication and a major cause of mortality after transplant. The estimation of right ventricular systolic function and right ventricular end diastolic pressure during RHC can help:

• To withhold transplant and provide right heart support (like ECMO or Right ventricular assist device)

• To plan for right heart support during transplant surgery

1. 💉 Help decide optimal medical management before transplant:

The results of RHC help guide optimal medical management prior to transplant, including:

• Diuretics for fluid overload

• Vasodilators or inotropic drugs for low cardiac output

• Pulmonary vasodilators for pulmonary hypertension if present

This helps get the recipient in the best possible condition for transplant.

1. 📋 Needed for listing decision based on international unified criteria:

Right heart catheterization is a mandatory procedure for determining listing for heart transplant in most transplant programs including those in India. According to ISHLT (International Society for Heart and Lung Transplantation), guidelines for listing patients for heart transplantation, Right heart catheterisation is a mandatory procedure.

The data from RHC is needed to decide on donor-recipient match for transplant.

1. ⚠️ Can detect occult increased left atrial pressure /pulmonary hypertension:

Some patients with good left ventricular function on echo may still have poor filling pressures, increased PVR (pulmonary vascular resistance) and low CO (cardiac output). RHC can help detect these occult increased pressures and help decide on timing of transplant.

👨‍⚕️ “Right Heart Catheterization is the compass without which we cannot navigate the crossroads of cardiac transplantation.” –Dr. Srinath Vijayasekharan, Cardiothoracic surgeon, Rela Hospital

“It helps us to make the heart transplantation journey for our patients, smooth and safe.” –Dr. Senthil Kumar, Cardiothoracic surgeon, Rela Hospital.

🌟 At Rela, RHC is done:

🫀 In designated cardiac catheterisation lab with proper monitoring

👨‍⚕️ By experienced transplant team

🔐 With proper safety measures and precautions to reduce risks and complications.

🫀 When preparing for a new lease of life with a new heart, every pressure matters.

📍 Right Heart study at Rela Hospital.

👨‍⚕️ Consult Dr. Srinath Vijayasekharan & Dr. Senthil Kumar.