Gamba A, Fiocchi R, Mamprin F, Senni M
Unità Operativa di Cardiochirugia Azienda Ospedaliera Ospedali Riuniti di Bergamo.
G Ital Cardiol. 1999 Aug;29(8):918-24.
Right heart failure due to elevated PVR is one of the major causes of mortality and morbidity after orthotopic heart transplantation. In 5 patients (median age 14 years) with dilated or restrictive cardiomyopathy and important elevation of the PVR, a heterotopic heart transplantation was performed using the technique reported by Yacoub (the donor pulmonary artery was implanted on the recipient right atrium). All the patients presented with at least two of the following parameters: PVR/m2 > 6 U, transpulmonary gradient > 15 mmHg, mean pulmonary pressure > 50 mmHg. One patient with restrictive cardiomyopathy died three months after transplantation of severe failure of the native right ventricle. The other four patients, with a mean follow-up of 29 months, are in good clinical and hemodynamic condition and later post-operative catheterizations showed a progressive reduction of the pulmonary pressure.
Our experience suggests that this type of heterotopic heart transplantation can be performed successfully in patients with secondary pulmonary hypertension. Particular attention should be paid to patients with restrictive cardiomyopathy and important right ventricle dysfunction, in which a complete heterotopic heart transplantation could be a better solution.
因肺血管阻力（PVR）升高导致的右心衰竭是原位心脏移植后死亡和发病的主要原因之一。在5例（中位年龄14岁）患有扩张型或限制性心肌病且PVR显著升高的患者中，采用Yacoub报道的技术进行了异位心脏移植（将供体肺动脉植入受体右心房）。所有患者均至少具备以下参数中的两项：PVR/m²>6U、跨肺压差>15mmHg、平均肺动脉压>50mmHg。1例患有限制性心肌病的患者在移植后3个月因自身右心室严重衰竭死亡。其他4例患者平均随访29个月，临床和血流动力学状况良好，术后后期的导管检查显示肺动脉压逐渐降低。
我们的经验表明，这种类型的异位心脏移植可在继发性肺动脉高压患者中成功进行。对于患有限制性心肌病和严重右心室功能障碍的患者应给予特别关注，在这些患者中，完全异位心脏移植可能是更好的解决方案。
