JHLT Open最新文献

{"title":"Real-world experiences and treatment patterns among congenital heart disease patients with associated pulmonary vascular disease: Results from a real-world survey in the United States","authors":"Jordan D. Awerbach MD, MPH ,&nbsp;Carly J. Paoli PharmD, MPH ,&nbsp;Megan Scott BSc ,&nbsp;Gurinderpal Doad PharmD ,&nbsp;Julia Harley BSc ,&nbsp;Daniel Graham MSc ,&nbsp;Mark Small BSc ,&nbsp;Sumeet Panjabi PhD ,&nbsp;Leigh C. Reardon MD, FACC","doi":"10.1016/j.jhlto.2025.100326","DOIUrl":"10.1016/j.jhlto.2025.100326","url":null,"abstract":"<div><h3>Background</h3><div>Limited data exist on the use of drugs in patients with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD). Therefore, we evaluated their real-world patient journey, including symptomatology, diagnostic pathway, treatment patterns, and guideline adherence.</div></div><div><h3>Methods</h3><div>Data were drawn from the Adelphi Real World pulmonary hypertension congenital heart disease Disease Specific Programme (DSP), a cross-sectional survey of clinicians and patients with PAH-CHD or Fontan circulation associated with elevated pulmonary vascular resistance (PVR). Data were collected in the United States from November 2021 to May 2022. Analyses were descriptive.</div></div><div><h3>Results</h3><div>Overall, 51 clinicians reported data for 191 patients with PAH-CHD or Fontan circulation associated with elevated PVR. Fifty-eight patients voluntarily provided data. Overall, 10.5% of patients had a gap of ≥1 year in their disease management. Mean (standard deviation, SD) time from pulmonary hypertension symptom onset to diagnosis/confirmation was 1.7 (2.2) years. Overall, 75.0% of patients underwent a right heart catheterization (RHC) at diagnosis/confirmation. Clinicians reported that 75.9% of patients were prescribed treatment for their PAH-CHD or elevated PVR. Pulmonary hypertension specific therapy was prescribed as combination therapy for 47.6% of patients prescribed pulmonary hypertension specific treatment.</div></div><div><h3>Conclusions</h3><div>Patients experienced delays to diagnosis and gaps in congenital heart disease management. We observed low utilization of RHC and combination therapy. Key unmet needs in this population include more frequent testing to shorten time-to-diagnosis and proactive management with initial combination therapy.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100326"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144589095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of lung transplants utilizing donors from outside the continental United States","authors":"Reed T. Jenkins MD ,&nbsp;Emily L. Larson MD ,&nbsp;Alice L. Zhou MD ,&nbsp;Jessica M. Ruck MD, PHD ,&nbsp;David J. Farhat MD ,&nbsp;Helene Rached DO ,&nbsp;Al-Faraaz Kassam MD, MBA ,&nbsp;Christian A. Merlo MD ,&nbsp;Ramon A. Riojas MD ,&nbsp;Errol L. Bush MD","doi":"10.1016/j.jhlto.2025.100324","DOIUrl":"10.1016/j.jhlto.2025.100324","url":null,"abstract":"<div><h3>Background</h3><div>Efforts to expand the lung transplant donor pool have included re-evaluating geographic restrictions and accepting longer distances between donor and recipient centers. We evaluated the use of organs from donors outside the continental United States.</div></div><div><h3>Methods</h3><div>Adult lung-only transplants from 2005-2022 in the United Network for Organ Sharing database were included and categorized based on donor location (mainland US vs nonmainland). Survival out to 1 and 5 years post-transplant was evaluated using time-to-event analysis and multivariable Cox regression.</div></div><div><h3>Results</h3><div>Of 35,638 transplants, 389 (1.1%) utilized nonmainland donors. Nonmainland donors were younger (median 28 vs 33 years, <em>p</em> &lt; 0.001), had lower body mass index (24 [22-27] vs 25 [23-29] kg/m², <em>p</em> &lt; 0.001), and were less likely to have a &gt;20 pack-year smoking history (4.9% vs 9.1%, <em>p</em> = 0.004). Recipients of nonmainland vs mainland lungs were less likely to have restrictive pathology (57.2% vs 59.5%, <em>p</em> &lt; 0.001) and had lower body mass index (25 [21-28] vs 26 [22-29] kg/m², <em>p</em> = 0.002). Nonmainland transplants had greater distances between donor and recipient centers (1,256 [1,072-1405] vs 148 miles [29-310], <em>p</em> &lt; 0.001) and longer ischemic times (7.7 [6.9-8.8] vs 5.2 [4.2-6.3] hours, <em>p</em> &lt; 0.001). Transplants utilizing nonmainland and mainland donors had similar post-transplant survival out to 1 (aHR 1.03 [95% CI 0.78-1.35], <em>p</em> = 0.86) and 5 years (aHR 0.87 [95% CI 0.73-1.04], <em>p</em> = 0.13).</div></div><div><h3>Conclusions</h3><div>Transplants utilizing nonmainland donors had lower-risk donor and recipient characteristics. Despite greater distances and ischemic times, these transplants had similar post-transplant survival compared to transplants using mainland donors, supporting the use of select donors from outside the mainland United States.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100324"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indications for pediatric lung transplantation in 2025: A new era","authors":"Nicholas Avdimiretz MD FRCPC ,&nbsp;Don Hayes Jr., MD MS ,&nbsp;Melinda Solomon MD MSc FRCPC ,&nbsp;Nicolaus Schwerk MD ,&nbsp;Christian Benden MD MBA FCCP","doi":"10.1016/j.jhlto.2025.100323","DOIUrl":"10.1016/j.jhlto.2025.100323","url":null,"abstract":"<div><div>The year 2025 marks an important landmark: almost 40 years since the first pediatric lung transplant (LTX), over 3-5 years since the availability of elexacaftor/tezacaftor/ivacaftor in several countries, and 5-10 years since striking shifts were reported in the diagnoses that accounted for pediatric LTX. We review historic indications for pediatric LTX, highlighting shifts in these over time, and analyze data from the ISHLT International Thoracic Organ Transplant Registry, United Network of Organ Sharing, Canadian Cystic Fibrosis (CF) Registry, and other databases up to the present day. Currently, pediatric CF-related LTX cases are at record lows in many countries. Non-retransplant bronchiolitis obliterans seems to be on the rise as a transplant indication in pediatrics, which is particularly true in the younger age group per ISHLT data. Childhood interstitial lung disease is increasing as an indication, especially in North America. Idiopathic pulmonary arterial hypertension (IPAH) and pulmonary hypertension as a whole now account for record highs as indications for pediatric LTX around the world, with IPAH alone now accounting for nearly 20% of pediatric LTX in the United States, for instance. This information will help guide future international pediatric thoracic transplant consensus guidelines around candidate selection and optimization, placing more emphasis on non-CF considerations.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100323"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144534267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of extracellular vesicles in chronic lung allograft dysfunction and response to extracorporeal photopheresis","authors":"Rachel E. Crossland ,&nbsp;Steven J. Bolton ,&nbsp;Andrew J. Fisher","doi":"10.1016/j.jhlto.2025.100322","DOIUrl":"10.1016/j.jhlto.2025.100322","url":null,"abstract":"<div><div>Current research highlights the growing role of extracellular vesicles (EV) in mechanisms of lung allograft dysfunction. In particular, EVs are involved in antigen presentation, where they are released from lung allografts and express tissue associated antigens which are recognized by recipient immune cells, thereby triggering an immune response against the transplanted lung. In the context of chronic rejection, patients with chronic lung allograft dysfunction (CLAD) demonstrate elevated levels of EVs, which contain diverse molecular cargo that can influence the alloimmune response. This highlights the potential of EVs as translatable biomarkers for the early detection, prediction, or diagnosis of lung allograft dysfunction. The mechanisms by which EVs contribute to this process may include immune cell activation, epithelial-to-mesenchymal transition, and disruption of angiogenesis. Furthermore, their immunomodulatory potential is evident by their emerging involvement in regulating the immune response during extracorporeal photopheresis (ECP) therapy following lung transplantation, where they contribute to the balance of immunoregulatory and autoimmune responses within a highly interwoven network. While ECP shows promise for broader or earlier use in solid organ transplantation, its application is limited by a lack of mechanistic understanding. This review summarizes the role of EVs in development of lung allograft dysfunction, their involvement in immunomodulation, and the current literature exploring their potential role in the mechanisms of ECP therapy.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100322"},"PeriodicalIF":0.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right ventricular mechanical support as a bridge to lung transplantation: A literature review of current practices","authors":"Michaela Orlitová ,&nbsp;Bert Demeulenaere ,&nbsp;Dieter Van Beersel ,&nbsp;Dirk E. Van Raemdonck ,&nbsp;Robin Vos ,&nbsp;Laurens J. Ceulemans ,&nbsp;Steffen Rex ,&nbsp;Laurent Godinas ,&nbsp;Tom Verbelen ,&nbsp;Arne P. Neyrinck","doi":"10.1016/j.jhlto.2025.100316","DOIUrl":"10.1016/j.jhlto.2025.100316","url":null,"abstract":"<div><div>Extracorporeal life support (ECLS) serves as a bridge to lung transplantation (BTT) for patients with acute respiratory failure (ARF) or right ventricular (RV) dysfunction/failure (RVD/RVF). Proper assessment and management of RV function in BTT patients are crucial for successful outcomes. However, there is a lack of consensus on standardized RV assessment strategies or optimal ECLS configurations. We aim to synthesize current evidence on RVD/RVF assessment and management in BTT patients requiring ECLS, providing a foundation to aid development of standardized clinical algorithms.</div><div>A scoping literature search across PubMed, Embase, Web of Science, Cochrane Library, and grey literature was performed. Inclusion criteria comprised human studies reporting on RV assessment and/or management in BTT patients. Data on patient characteristics, RV assessment methods, and ECLS strategies were extracted. A total of 280 patients were identified. Acute respiratory failure (ARF) was the most common BTT indication (40.4%), followed by RVF (33.2%) and RVD (17.9%). Echocardiography (52.5%) and right heart catheterization (43.2%) were the primary RV assessment tools. However, reporting of specific parameters of RV assessment was inconsistent. Furthermore, we report important variability of practice in ECLS strategies: VV-ECMO (38.8%) was the most common ECLS strategy, followed by VA-ECMO (31.1%), VAV-ECMO (8.2%), and OxyRVAD (13.2%). Based on our findings, bridging strategies currently lack guidance. As BTT is often confronted with dynamic changes over time, respiratory and circulatory ECLS indications may be overlapping. Therefore, a personalized patient approach is needed. We recommend implementing institutional guidelines and international standards to systematically capture this practice.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100316"},"PeriodicalIF":0.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical relevance and outcome of routine endomyocardial biopsy to detect rejection after heart transplantation","authors":"Leendert C. Kieviet BsC ,&nbsp;Steven A. Muller MD ,&nbsp;Mariusz K. Szymanski MD PhD ,&nbsp;Manon G. van der Meer MD PhD ,&nbsp;M. Louis Handoko MD PhD ,&nbsp;Saskia Z.H. Rittersma MD PhD ,&nbsp;Saskia C.A. de Jager ,&nbsp;Egidius E. van Aarnhem MD PhD ,&nbsp;Annelotte Vos MD ,&nbsp;Pim van der Harst MD PhD ,&nbsp;Linda W. van Laake MD PhD ,&nbsp;Marish I.F.J. Oerlemans MD PHD","doi":"10.1016/j.jhlto.2025.100320","DOIUrl":"10.1016/j.jhlto.2025.100320","url":null,"abstract":"<div><h3>Background</h3><div>Endomyocardial biopsy has been the cornerstone of monitoring rejection after heart transplantation for decades. Although recommendations advise routine biopsies during the first 3-12 months, this timeframe is broad, and intercenter variability persists in its application. Here, we report the yield and complication rate of routine endomyocardial biopsies during the past 36 years of post-transplantation care to monitor acute cellular rejection.</div></div><div><h3>Methods</h3><div>In this retrospective, single-center study, we collected all routine biopsy data after transplantation between 1986 and 2022. The total number of biopsies, type of rejection, complications, and survival were analyzed in the total population as well as per different endomyocardial biopsy protocol over time period (Period 1: 1986-1994; Period 2: 1994-2009; Period 3: 2009-2022).</div></div><div><h3>Results</h3><div>In 474 patients (71.1% male, age at transplant 47.7 ± 12.6 years), 8185 routine biopsy procedures were performed: 29.9 ± 11.1 per patient for Period 1 (<em>n</em> = 83), 16.9 ± 3.8 for Period 2 (<em>n</em> = 220) and 11.6 ± 2.4 for Period 3 (<em>n</em> = 171). Complication rate was low (1.7%; <em>n</em> = 139/8185) and 19.8% (<em>n</em> = 94/474) patients experienced clinically-relevant rejection (≥2R) which mainly occurred &lt;6 months post-transplantation (89.4%; <em>n</em> = 84/94). The incidence of rejection decreased over time, leading to an improved rejection-free survival (<em>p</em> &lt; 0.001) with a subsequent increase in Number-Needed-to-Diagnose. Importantly, severe acute cellular rejection did not occur in Period 3 in the first year post-transplantation.</div></div><div><h3>Conclusion</h3><div>Acute cellular rejection, including clinically-relevant rejection, has declined significantly over time and is rare beyond 6 months post-transplantation. A low-frequency approach seems feasible and safe, which is relevant for the transition towards less-invasive protocols to detect rejection, especially early post-transplantation.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100320"},"PeriodicalIF":0.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144502645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of disease location and laterality on hemodynamic response following pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension","authors":"Bryan O. Pérez Martínez MD ,&nbsp;Gabriella V. Rubick MD ,&nbsp;Avi Toiv MD ,&nbsp;Sidney Perkins MD ,&nbsp;Jorge Vinales ,&nbsp;Victor M. Moles MD ,&nbsp;Vallerie V. McLaughlin MD ,&nbsp;Thomas M. Cascino MD MSc ,&nbsp;Bryan Kelly DO ,&nbsp;Gillian Grafton DO ,&nbsp;Rana Awdish MD ,&nbsp;Jonathan W. Haft MD ,&nbsp;Vikas Aggarwal MD MPH","doi":"10.1016/j.jhlto.2025.100314","DOIUrl":"10.1016/j.jhlto.2025.100314","url":null,"abstract":"<div><h3>Background</h3><div>In patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing pulmonary thromboendarterectomy (PTE), obstructive disease burden predicts positive hemodynamic responsiveness. However, the effect of disease location (upper, middle, or lower lobes) and lung laterality (right or left) has not been studied.</div></div><div><h3>Objectives</h3><div>Examine the effect of obstructive disease location and laterality on hemodynamic response following PTE.</div></div><div><h3>Methods</h3><div>This analysis is a retrospective cohort study of 56 consecutive patients diagnosed with CTEPH who underwent PTE at the University of Michigan Hospital between August 2019 and July 2022. Disease burden, location, and laterality were assessed on invasive pulmonary angiography (IPA), and lobar segments were assigned a score based on these features and correlated with an absolute change in pulmonary vascular resistance (PVR) following PTE. The relationship between disease burden and hemodynamic responsiveness was modeled using linear regressions with <em>R</em>² reported as a measure of correlation.</div></div><div><h3>Results</h3><div>Most patients were World Health Organization (WHO) class III or IV (<em>n</em> = 47; 83.9%) and had a history of acute pulmonary embolism (<em>n</em> = 51; 91.1%). A modest correlation between patients’ overall disease burden and absolute change in PVR was noted, with the strongest contributions from the right lower lobe (RLL), right middle lobe (RML), and left lower lobe (LLL) (<em>R</em>² = 0.16, 0.10, and 0.03, respectively).</div></div><div><h3>Conclusion</h3><div>Disease location in the RLL, RML, and LLL may predict hemodynamic improvement in patients with CTEPH undergoing PTE.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100314"},"PeriodicalIF":0.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychosocial considerations in pediatric heart transplantation: Initial validation of the Pediatric Psychosocial Assessment Tool at a single center","authors":"Michael O. Killian PhD, MSW ,&nbsp;Sonnie E. Mayewski MSW ,&nbsp;Schyler E. Brumm MSW ,&nbsp;Zhe He PhD ,&nbsp;Dipankar Gupta MBBS, DCH, MD","doi":"10.1016/j.jhlto.2025.100319","DOIUrl":"10.1016/j.jhlto.2025.100319","url":null,"abstract":"<div><h3>Background</h3><div>Pre-transplant psychosocial assessment, in conjunction with medical and surgical evaluation, is a critical component of determining pediatric heart transplant candidacy. Psychosocial factors such as family dynamics, health literacy, mental health, financial stability, and adherence potential are often multidimensional and interdependent, making their assessment both vital and complex. However, few standardized tools exist to guide these evaluations in pediatric heart transplant settings, and even fewer have demonstrated empirical validity or predictive value. To address this gap, the Pediatric Psychosocial Assessment Tool (PPAT) was developed to provide a structured, semi-quantitative framework for evaluating psychosocial risk in pediatric transplant candidates.</div></div><div><h3>Methods</h3><div>This study presents initial validation data for the PPAT, based on 189 assessments conducted at a large pediatric heart transplant center. The tool evaluates nine psychosocial domains, assigns risk ratings, and yields a total risk score.</div></div><div><h3>Results</h3><div>Confirmatory factor analysis supported the unidimensional structure of the tool, and internal consistency was strong (α = 0.89). Higher PPAT scores were significantly associated with lower odds of being listed for transplant by the center’s multidisciplinary medical review board (MRB), even after accounting for clinical factors. Domain-level findings revealed financial and health literacy issues as commonly identified risk areas.</div></div><div><h3>Conclusion</h3><div>The PPAT holds promise as a valid, reliable, and clinically useful instrument for guiding MRB discussions and targeting interventions to support high-risk families. Future directions include expanding implementation to other centers and integrating the PPAT into digital platforms using artificial intelligence and natural language processing to enhance efficiency, consistency, and patient-centered care.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100319"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144534293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Synchronized biatrial arrhythmias: Anatomic differences in biatrial versus bicaval orthotopic heart transplants drive arrhythmogenic sequelae","authors":"Michael C. Downey MD ,&nbsp;Edwin Zishiri MD","doi":"10.1016/j.jhlto.2025.100321","DOIUrl":"10.1016/j.jhlto.2025.100321","url":null,"abstract":"<div><div>A 37-year-old male with a history of familial Titin (TTN) gene mutation and orthotopic heart transplant (OHT) 20 years prior presented for evaluation of persistent atrial arrhythmias, including atrial fibrillation and atrial flutter. Despite the lower risk for atrial fibrillation in OHT patients due to surgical anastomosis isolating the pulmonary veins, biatrial OHT, which preserves the native atrial connection (unlike bicaval OHT), allows for arrhythmogenesis on both the donor and recipient atrial sides. This patient's case illustrates a unique arrhythmic mechanism where electrical reentry between residual and transplanted atrial myocardium resulted in multiple distinct atrial tachycardias. Intracardiac electrograms revealed sinus rhythm along with atrial tachycardia, particularly in the posterior left atrium and the right atrium. High-density voltage mapping identified significant scarring along the anterior and lateral right atrium, likely due to the prior recipient-to-donor right atrial anastomosis. A narrow gap of viable tissue indicated electrical reconnection across the suture line, facilitating multiple micro-reentrant circuits. Radiofrequency ablation (RFA) was performed to interrupt this excitable gap, isolating the native and donor atrial tissues. The RFA lesion set transected the anastomosis site and extended to the cavo-tricuspid isthmus, reestablishing electrical isolation. This case highlights the importance of understanding the biatrial OHT anatomy for targeted electrophysiologic interventions, selective placement of reference electrodes/catheters for mapping, and the need for careful consideration of electrical reconnection across surgical anastomoses to prevent arrhythmogenesis.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100321"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chest wall strapping in a porcine model: Dynamic dysanapsis dilates airways for optimized function of the “oversized” lung","authors":"Eric Abston ,&nbsp;Michael Eberlein","doi":"10.1016/j.jhlto.2025.100317","DOIUrl":"10.1016/j.jhlto.2025.100317","url":null,"abstract":"<div><div>Chest-Wall-Strapping (CWS), a technique forcing the lung to operate at low volumes, is a model for an oversized lung allograft. Dynamic-dysanapsis describes airway dilation mediated by increased elastic recoil from CWS. We hypothesized that Dynamic-dysanapsis can be quantified via the Dysanapsis-Ratio, defined as the airway-size to lung-volume ratio.</div><div>Farm-raised pigs (n=3) were mechanically ventilated. Stepwise CT-images throughout the lung deflation limb in control and CWS conditions were analyzed quantifying airway dimensions and lung volume.</div><div>CWS (30%-reduction in lung-volume) was associated with a significant increase in the Dysanapsis-Ratio (p&lt;0.001). CWS increased airway distensibility at the 6th major branch of the right lower airway (27±7% vs. 39±5%, p=0.04).</div><div>The dysanapsis-ratio allows quantification of dynamic-dysanapsis with CWS. Dynamic-dysanapsis appears to be a compensatory mechanism to preserve pulmonary gas exchange by airway dilation when the lung is forced to operate at lower lung volumes. Dynamic-dysanapsis furthers the understanding of oversized allografts in lung transplantation.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100317"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}