Lung and heart-lung transplantation.

I NCREASED UNDERSTANDING AND AWARENESS OF congenital cardiac disease has allowed early identification of these children. Advances in surgical techniques, anesthesia, and medical treatment have rendered the majority of forms of congenital cardiac defects treatable. Therefore, the incidence of pulmonary hypertension related to the Eisenmenger syndrome should decrease. However, some patients need treatment for pulmonary hypertension despite repair of defects. Heart-lung and lung transplantation remain the therapeutic options when medical therapy fails. According to the registry of the International Society for Heart and Lung Transplantation, 25% of heart-lung and less than 1% of lung transplants have been performed for adult patients with congenital cardiac disease. Similarly, more than 40% of heartlung and 5% of lung transplants have been performed in children with congenital cardiac anomalies. The objective of this session is to address four major points: the cost-benefit and risk-benefit issues for lung or heart-lung transplantation versus currently available medical treatments, the allocation policies for these patients, the risk-benefit issue for lung versus heartlung transplant, and the use of ventricular assist devices in patients with biventricular failure as to allow successful isolated heart transplantation following improvement of pulmonary hemodynamics.