Heart candidate selection

For candidate selection several factors have to be assessed low left ventricular (LV) ejection fraction, right ventricular dysfunction, the New York Heart Association (NYHA) functional class, ventricular arrhythmias, measurement of functional capacity with determination of maximal oxygen consumption, hemodynamic measurements, pulmonary capillary resistance and the neurohumoral activation resulting from congestive heart failure (elevated plasma norepinephrine levels) (Aaron-SON et al. 1997 Doval et al. 1996 Gradman and Deedwania 1994 MANCiNietal. 1991 Stevenson et al. 1990). 

If the candidate has a slow disposition phase, suggesting distribution into some extravascular tissues, or if the preliminary toxicology experiments identify potential organs of toxicity, a preliminary tissue distribution and mass balance study can be designed to evaluate the radioactivity level versus time profile in selected tissues, such as liver, kidney, fat (for a lipophilic candidate), muscle, skin, heart, and brain, and to determine the primary route(s) and rate(s) of elimination. 

Secondary Pulmonary Hypertension. Secondary pulmonary hypertension is seen in some heart transplant candidates, and documenting the potential for reversibility when the primary defect is corrected is important in selecting appropriate heart transplant candidates and liver transplant patients as well. Aerosolized prostacyclin has been shown at least as effective as inhaled NO 40 ppm for this purpose in heart transplant candidates [170], while aerosolized epoprostenol has been shown similarly useful in liver transplant candidates. Delivery of iloprost was faster with an ultrasonic nebulizer but equally efficacious as compared to a jet nebulizer [171]. The role of aerosolized prostacyclin and related medications for pulmonary hypertension and for diagnostic evaluation of transplant candidates remains to be proven. Certainly, a successful aerosol treatment for pulmonary hypertension would be well received because of the inconvenience of the current method of constant infusion via an indwelling catheter. From an economic viewpoint, the market is small, so the chance of recovery of investment in new treatment would be limited. 

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