Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Eur J Cardiothorac Surg. 2011 Dec;40(6):1374-82; discussion 1382-3. doi: 10.1016/j.ejcts.2011.04.033. Epub 2011 Sep 7.
We aimed to evaluate the adaptive growth and remodeling behavior of the transplanted heart in pediatric heart-transplant recipients by comparing donor body surface area (BSA) and cardiac dimensions during transplantation with the corresponding parameters of the recipient over a period of time.
A retrospective review of medical and echocardiographic records of 167 children (8.65 ± 5.98, median 9; range 0-17 years) who underwent orthotopic heart transplantation between 1987 and March 2010 was done.
In the first 30 days post-transplantation, right- and left-ventricular end-diastolic diameters, volumes, and myocardial mass were found to be significantly increased (z score 3.96, p < 0.000) in relation to the recipients' BSA. Within the first year of post-transplantation, there was a significant reduction in the right-ventricular diameter (z score, -1.0 to +1.6, p = 0.000), left-ventricular diameter (z score -1.0 to +1.9, p = 0.000), right-ventricular end-diastolic volume (z score -1.3 to +1.9, p = 0.000) and left-ventricular end-diastolic volume (z score -1.3 to +1.8, p = 0.000), right-ventricular mass (z score, -1.4 to +1.7, p = 0.000) and left-ventricular mass (z score, -1.4 to +1.8, p = 0.000). During subsequent follow-up periods of 2-5 and 6-10 years, the aforementioned cardiac dimensions and volumes increased appropriately in accordance to the BSA (p = 0.000). In all the cardiac dimensions and volumes measured, donor-recipient mismatch did not influence the continuous growth of the measured parameters, which was in accordance to the recipients' BSA over time. Kaplan-Meier survival analysis showed a survival rate of 61.7% at 10 years. There is no statistically significant difference in survival rate among patients with varying donor-recipient weight ratios and donor-recipient BSA ratios (p = 0.53).
This study demonstrates that the transplanted heart undergoes remodeling processes and grows adaptively, in accordance to the BSA, over a period of time.
通过比较供体体表面积（BSA）和移植时心脏尺寸与受者在一段时间内的相应参数，评估儿童心脏移植受者移植心脏的适应性生长和重塑行为。
回顾性分析 1987 年至 2010 年 3 月期间接受原位心脏移植的 167 名儿童（8.65±5.98，中位数 9；年龄 0-17 岁）的医疗和超声心动图记录。
移植后 30 天内，右心室和左心室舒张末期直径、容量和心肌质量与受者 BSA 相比显著增加（z 分数 3.96，p<0.000）。在移植后 1 年内，右心室直径（z 分数-1.0 至+1.6，p=0.000）、左心室直径（z 分数-1.0 至+1.9，p=0.000）、右心室舒张末期容积（z 分数-1.3 至+1.9，p=0.000）和左心室舒张末期容积（z 分数-1.3 至+1.8，p=0.000）、右心室质量（z 分数-1.4 至+1.7，p=0.000）和左心室质量（z 分数-1.4 至+1.8，p=0.000）显著降低。在随后的 2-5 年和 6-10 年随访期间，上述心脏尺寸和容积按照 BSA 适当增加（p=0.000）。在所测量的所有心脏尺寸和容积中，供体-受者不匹配并不影响测量参数的持续增长，这与受者随时间推移的 BSA 相符。Kaplan-Meier 生存分析显示 10 年生存率为 61.7%。供体-受者体重比和供体-受者 BSA 比不同的患者生存率无统计学差异（p=0.53）。
本研究表明，移植心脏在一段时间内会根据 BSA 进行重塑和适应性生长。
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