Bombardini Tonino, Gherardi Sonia, Leone Ornella, Sicari Rosa, Picano Eugenio
CNR, Institute of Clinical Physiology, Pisa, Italy.
Cardiovasc Ultrasound. 2013 Aug 2;11:27. doi: 10.1186/1476-7120-11-27.
Due to the shortage of donor hearts, the criteria for acceptance have been considerably expanded. Hearts with regional or global left ventricular dysfunction are excluded from donation, but stress echo might be useful to identify patients with reversible wall motion abnormalities, potentially eligible for donation.
Six marginal candidate donors (mean age, 40 ± 13 years; three men) were enrolled. Resting echocardiography showed in all subjects a LV ejection fraction ≥ 45% (mean 51 ± 5%), but multiple risk factors were present. All donors had either global or discrete wall motion abnormalities: Wall Motion Score Index (WMSI) rest = 1.33 ± 0.25. Stress echocardiography was performed with the dipyridamole high dose of 0.84 mg/kg given over 6 min.
The stress echo results were abnormal in three donors (WMSI rest = 1.51 ± 0.19 vs peak = 1.41 ± 0.30). These hearts were excluded from donation and cardiac pathology verification was available in two cases of confirmed LV myocardial fibrosis and/or severe coronary stenosis. The remaining three hearts improved during stress (WMSI rest = 1.15 ± 0.13 vs peak = 1.04 ± 0.06) and were transplanted uneventfully. Recipients (three males, mean age 53 ± 4 years) underwent post-TX coronary angiography, IVUS and endomyocardial biopsies. No recipient had primary graft failure, and all showed normal coronary angiography and normal LV function (EF = 57 ± 6%; WMSI = 1 ± 0) at 1-month post-TX. The recipients were alive at 12-month median follow-up.
Dipyridamole stress echo performed in brain-dead potential donors with LV resting global or discrete wall motion abnormalities identifies hearts with severe morphologic abnormalities excluded from donation (with fixed response during stress echo) from hearts eligible for donation, showing improvement in regional wall motion during stress (viability response) and normal function and coronary anatomy following transplantation.
由于供体心脏短缺，心脏接受标准已大幅放宽。左心室局部或整体功能障碍的心脏被排除在捐献范围之外，但负荷超声心动图可能有助于识别具有可逆性室壁运动异常的患者，这些患者有可能符合捐献条件。
纳入6名边缘性候选供体（平均年龄40±13岁；3名男性）。静息超声心动图显示所有受试者左心室射血分数≥45%（平均51±5%），但存在多种危险因素。所有供体均有整体或局灶性室壁运动异常：静息壁运动评分指数（WMSI）=1.33±0.25。采用潘生丁高剂量0.84mg/kg在6分钟内静脉输注进行负荷超声心动图检查。
3名供体的负荷超声心动图结果异常（静息WMSI=1.51±0.19，峰值=1.41±0.30）。这些心脏被排除在捐献范围之外，2例经心脏病理证实存在左心室心肌纤维化和/或严重冠状动脉狭窄。其余3例心脏在负荷试验中改善（静息WMSI=1.15±0.13，峰值=1.04±0.06），并顺利进行了移植。受体（3名男性，平均年龄53±4岁）术后接受了冠状动脉造影、血管内超声和心内膜心肌活检。无一例受体发生原发性移植功能障碍，所有受体在术后1个月时冠状动脉造影正常，左心室功能正常（射血分数=57±6%；WMSI=1±0）。受体在中位随访12个月时存活。
对脑死亡潜在供体进行潘生丁负荷超声心动图检查，这些供体存在左心室静息整体或局灶性室壁运动异常，可识别出因严重形态学异常而被排除在捐献范围之外的心脏（负荷超声心动图表现为固定反应），与有存活能力反应（负荷试验中局部室壁运动改善）且移植后功能和冠状动脉解剖正常、符合捐献条件的心脏。
