Impact of Atelectasis on RVEDP Following Orthotropic Heart Transplantation

Study Overview
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Brief Summary
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Following orthoptopic heart transplantation (OHT), children undergo surveillance cardiac catheterizations to assess for signs of rejection including muscle biopsy as well as pressure measurements to guide post transplant treatment regiments. These procedures are done under general anesthesia which promotes lung tissue collapse (atelectasis). What is not known is the effect of atelectasis on intracardiac pressures which are a critical area of monitoring post-transplant patients for rejection.

Detailed Description
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Following orthoptopic heart transplantation (OHT), children undergo surveillance cardiac catheterizations to assess for signs of rejection including muscle biopsy as well as pressure measurements. These procedures are done under general anesthesia which promotes lung tissue collapse (atelectasis). Atalectaisis is known to alter intra-thoracic pressures and cardiac loading conditions. What is not known is the effect of atelectasis on intracardiac pressures which are a critical area of monitoring post-transplant patients for rejection. Therefore, the aim of this study is to identify if atelectasis impacts the pressure measurements obtained during cardiac catheterization.

Official Title
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Impact of Atelectasis and Lung Recruitment on RVEDP Measurement in Children Undergoing Cardiac Catheterization for Surveillance Following Orthotropic Heart Transplantation

Conditions
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Heart Transplant Failure, Anesthesia

Intervention / Treatment
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* Other: Lung Recruitment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients having undergone orthotropic heart transplantation Patients requiring routine heart catheterization for post-transplant surveillance General anesthesia Exclusion Criteria: Patient/parental refusal Patients with suspected or known acute rejection Known anti-rejection medication non-compliance Patients within 1 year following heart transplant Home oxygen requirement Previous lung surgery (e.g., lobectomy) other than biopsy Lung transplantation Known pulmonary fibrosis Known pulmonary hypertension (>1/2 systemic) Sedation without the use of an airway device Active respiratory infection -Inability to provide recruitment breaths >25mmHg -Cardiomegaly Recipient/donor size mismatch
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Right ventricular End diastolic pressure<br>Measurement of pre and post recruitment right ventricular end diastolic pressure | Other: Lung Recruitment<br>* Lung Recruitment will be performed during general anesthesia to reduce areas of atelectasis<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants with reduction of right ventricular end diastolic pressure of 3mmHg or greater | Change of the right ventricular end diastolic pressure from pre and post recruitment breaths | 10 minutes |