Cabo J, Castejón R, Cordovilla G, Rosembloom M, Gamallo C, Laschinger J, Alvarez F
Servicio de Cirugía Cardíaca Pediátrica, Hospital Infantil La Paz, Universidad Autónoma, Madrid.
An Esp Pediatr. 1989 Sep;31 Suppl 39:64-70.
Heart transplantation in children with end-stage heart disease or severe congenital heart defect with uncertain surgical palliation, like the hypoplastic left heart syndrome, has become an accepted form of therapy in certain selected Medical Centers. Increasing number of heart transplantation in children have resulted from increased survival attributable to the introduction of cyclosporine. Nevertheless, the diagnosis of rejection in infants and children remains controversial being a great challenge derived by the need for repetitive and routine heart biopsies. Taking in mind that a non-invasive electrophysiologic method could be considered a promising method for monitoring heart allograft rejection the present study was begun. A total of 306 heart transplantation was performed, 206 heterotopic on rats and 30 orthotopic on dogs. Non-invasive monitoring of heart rejection was made by electrophysiologic techniques using an epicardial lead implanted on the donor heart. R wave and slew-rate measurements were performed daily at 30', primero, segundo, tercero quinto and séptimo day postransplant. These measurements were later compared to histopathologic studies. R wave and slew-rate values of alogenic or rejecting hearts were found to decrease significantly as compared to singenic or non-rejecting heart along the days. This non-invasive electrophysiologic method may be considered a promising and suitable method for monitoring heart allograft rejection.
对于患有终末期心脏病或严重先天性心脏缺陷且手术姑息治疗效果不确定的儿童，如左心发育不全综合征，心脏移植已在某些选定的医疗中心成为一种被认可的治疗方式。由于环孢素的引入提高了生存率，儿童心脏移植的数量不断增加。然而，婴儿和儿童排斥反应的诊断仍然存在争议，因为需要重复进行常规心脏活检，这是一个巨大的挑战。考虑到非侵入性电生理方法可能是监测心脏同种异体移植排斥反应的一种有前景的方法，本研究就此展开。共进行了306例心脏移植，其中206例在大鼠身上进行异位移植，30例在狗身上进行原位移植。通过使用植入供体心脏的心外膜导联的电生理技术对心脏排斥反应进行非侵入性监测。在移植后的第30天、第1天、第2天、第3天、第5天和第7天每天进行R波和斜率测量。这些测量结果随后与组织病理学研究进行比较。结果发现，与同基因或无排斥反应的心脏相比，异体或有排斥反应的心脏的R波和斜率值在几天内显著降低。这种非侵入性电生理方法可被认为是监测心脏同种异体移植排斥反应的一种有前景且合适的方法。
