La Falce Sabrina, Arpesella Giorgio, Gherardi Sonia, Bombardini Tonino, Picano Eugenio
Istituto di Fisiologia Clinico, Consiglio Nazionale delle Ricerche, Pisa.
Recenti Prog Med. 2011 May;102(5):207-11. doi: 10.1701/659.7670.
The heart transplant is a treatment of the heart failure, which is not responding to medications. To counteract heart donor shortage, we should screen aged potential donor hearts for initial cardiomyopathy and functionally significant coronary artery disease, in order to exclude donors with a history of cardiac disease. A simple way to evaluate this should be stress echocardiography.
A marginal donor (a 57 year old woman meeting legal requirements for brain death) underwent a transesophageal (TE) dipyridamole stress echo (6 minutes accelerated protocol) to rule out moderate or severe heart and coronary artery disease. Wall motion was normal at baseline and at peak stress, without signs of stress inducible ischemia, and there was no latent myocardial dysfunction. The marginal donor heart was transplanted to a recipient marginal for co-morbidity (a 63 year old man with multiple myeloma and cardiac amyloidosis , chronic severe heart failure, NYHA class IV). The transplanted heart was assessed normal for dimensions and ventricular function at transthoracic (TT) echocardiography on post-transplant day 7. Coronary artery disease was ruled out at coronary angiography one month after transplant.
For the first time stress echo was successfully used for the selection of hearts "too good to die", representing a critical way to solve the mismatch between donor need and supply.
心脏移植是治疗药物治疗无效的心力衰竭的一种方法。为应对心脏供体短缺的问题，我们应筛查老年潜在供体心脏是否存在原发性心肌病和具有功能意义的冠状动脉疾病，以排除有心脏病史的供体。评估这一情况的一种简单方法是负荷超声心动图检查。
一名边缘供体（一名符合脑死亡法律要求的57岁女性）接受了经食管（TE）双嘧达莫负荷超声心动图检查（6分钟加速方案），以排除中度或重度心脏及冠状动脉疾病。静息状态和负荷峰值时室壁运动正常，无负荷诱发缺血迹象，且无潜在心肌功能障碍。该边缘供体心脏被移植给了一名因合并症而处于边缘状态的受体（一名63岁男性，患有多发性骨髓瘤和心脏淀粉样变性，慢性重度心力衰竭，纽约心脏协会心功能IV级）。移植后第7天经胸（TT）超声心动图检查显示移植心脏的大小和心室功能正常。移植后1个月冠状动脉造影排除了冠状动脉疾病。
负荷超声心动图首次成功用于筛选“质量良好”的心脏，这是解决供体需求与供应不匹配问题的关键方法。
