Document Detail

Heterotopic cardiac transplantation in infants and children.
MedLine Citation:
PMID:  9202685     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Children with advanced heart failure, particularly those with elevated pulmonary vascular resistance, pose a difficult management problem because the normal donor right ventricle cannot cope with the high pulmonary resistance and because of the relative shortage of donor organs of an appropriate size for this age group. METHODS: In an attempt to address these issues and evaluate the role of heterotopic transplantation in this context, we operated on 12 children, six boys and six girls, in the period between January 1, 1991, and March 31, 1996. Their ages ranged from 11 months to 15.2 years (mean 81.6 +/- 62.8 months) and their mean weight was 23.3 kg (range 7.6 to 56.8 kg). Eight patients (66.6%) had significant elevation of pulmonary artery pressure (pulmonary artery systolic pressure = 66 +/- 9.4 mm Hg, mean transpulmonary gradient = 22.3 +/- 3.4 mm Hg). In all patients the donor pulmonary artery was anastomosed to the recipient right atrium without the use of any prosthetic material. Ischemic times varied between 135 and 255 minutes (mean 182.1 +/- 30.7 minutes). The immunosuppression regimen included cyclosporine and azathioprine. Steroids were not routinely used. RESULTS: One patient died in the hospital of acute rejection on postoperative day 16. Three patients had lobe collapse within 1 week and all were treated successfully. Two late deaths (18.2%) occurred as a result of cardiac rejection 3 months and 2 years after the operations. Nine survivors (75%) are alive, active, and growing normally at a mean follow-up of 2.2 years (range 11 months to 4.75 years). Repeated cardiac catheterization performed in seven patients with preoperative pulmonary hypertension showed a slow progressive drop in mean pulmonary artery pressure. No significant change was observed in the function of the recipient hearts. CONCLUSION: We conclude that heterotopic heart transplantation is feasible for a selected group of children with good medium-term results, notably regression of pulmonary artery pressure, normal growth, and lack of long-term chest complications.
A Khaghani; F Santini; C M Dyke; O Onuzu; R Radley-Smith; M H Yacoub
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  113     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  1997 Jun 
Date Detail:
Created Date:  1997-07-15     Completed Date:  1997-07-15     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1042-8; discussion 1048-9     Citation Subset:  AIM; IM    
Harefield Hospital, Middlesex, United Kingdom.
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MeSH Terms
Anastomosis, Surgical
Blood Pressure
Cardiomyopathy, Dilated / surgery*
Cardiomyopathy, Restrictive / surgery*
Child, Preschool
Feasibility Studies
Heart Transplantation*
Pulmonary Artery / physiopathology,  surgery
Retrospective Studies
Stroke Volume
Transplantation, Heterotopic*
Treatment Outcome
Comment In:
J Thorac Cardiovasc Surg. 1997 Jun;113(6):1041   [PMID:  9202684 ]

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