PMC4008507_01
Echocardiography: 4-chamber view showing extremely enlarged left atrium (LA) and endocardial fibroelastosis (arrows) of left ventricle (LV) and mitral valve apparatus (a). Doppler maximum velocity of tricuspid insufficiency before initiation of medical therapy, indicating high systolic RV pressure of 111 mmHg (b). RV = right ventricle; RA = right atrium; IAS = interatrial septum.
CRIM.CARDIOLOGY2013-418565.001.jpg
PMC4008507_01_CRIM.CARDIOLOGY2013-418565.001.jpg
fig1
Tricuspid valve regurgitation was demonstrated with a maximum velocity of 5.28 m/sec presuming a systolic pulmonary artery pressure of 111 mmHg (Figure 1). 
Original recording of invasively measured mean pulmonary artery pressures on ICU (days 1-5) and initiation of administration of levosimendan, bosentan, and epoprostenol.
CRIM.CARDIOLOGY2013-418565.002.jpg
PMC4008507_01_CRIM.CARDIOLOGY2013-418565.002.jpg
fig2
After levosimendan, PCWP constantly decreased to values around 25 mmHg but mPAP increased up to 80 mmHg while cardiac index remained stable (Figure 2). 
Hemodynamic measurements before and after heart transplantation. Mean pulmonary artery pressure (mPAP) pulmonary capillary wedge pressure (PCWP) (a). Pulmonary vascular resistance index (PVRI) and cardiac index (CI) (b). Time course before (1) and after levosimendan (2), with bosentan/epoprostenol (3) and after heart transplantation (4).
CRIM.CARDIOLOGY2013-418565.003.jpg
PMC4008507_01_CRIM.CARDIOLOGY2013-418565.003.jpg
fig3
CI (values around 3.0 l/min/m2) and PCWP (values of around 24 mmHG). TPG thus decreased to values of 16 to 22 mmHg. Calculated PVRI was between 4 and 5 WU x m2 (Table 1, Figure 3).
Pathologic specimen of the explanted heart. Endocardial fibroelastosis of the left ventricle affecting the papillary muscles with thickened and shortened chordae tendineae and the aortic and mitral valve (reprinted from with permission from Elsevier).
CRIM.CARDIOLOGY2013-418565.004.jpg
PMC4008507_01_CRIM.CARDIOLOGY2013-418565.004.jpg
fig4