Heart-lung transplant is currently the therapy of choice for which of the following conditions?

B. Eisenmenger's syndrome due to single ventricle and truncus arteriosus.

C. Validated cardiomyopathy in a patient with cystic fibrosis and end-stage lung disease.

DISCUSSION: Heart-lung transplantation is now properly used only for persons with end-stage disease of the heart and lungs. Therefore, a patient with primary pulmonary hypertension and reasonably wellpreserved right ventricular function is best treated with a single or bilateral lung transplant. A person with complex congenital heart disease and Eisenmenger's syndrome or one who has end-stage disease of the heart and lungs would be better treated with combined heart-lung transplantation. Patients with Eisenmenger's syndrome secondary to relatively straightforward defects (e.g., atrial septal defect, ventricular septal defect) are best treated with concomitant correction of the congenital defect and single or bilateral lung transplantation. Similarly, the patient with end-stage emphysema with normal heart function can be treated very well with single or bilateral lung transplantation, preserving the donor heart for someone who truly has heart failure.