Birnbaum J, Ulrich S M, Schramm R, Hagl C, Lehner A, Fischer M, Haas N A, Heineking B
Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany.
Department of Cardiac Surgery, University Hospital, Ludwig-Maximilians-University, Munich, Germany.
Pediatr Transplant. 2017 Feb;21(1). doi: 10.1111/petr.12863. Epub 2016 Dec 7.
In pediatric heart transplantation, the size of the donor organ is an important criterion for organ allocation. Oversized donor hearts are often accepted with good results, but some complications in relation to a high donor-recipient ratio have been described. Our patient was transplanted for progressive heart failure in dilated cardiomyopathy. The donor-to-recipient weight ratio was 3 (donor weight 65 kg, recipient weight 22 kg). The intra-operative echocardiography before chest closure showed excellent cardiac function, no tricuspid valve regurgitation, and a normal central venous pressure. After chest closure, central venous pressure increased substantially and echocardiography revealed a severe tricuspid insufficiency. As other reasons for right ventricular dysfunction, that is, myocardial ischemia, pulmonary hypertension, and rejection, were excluded, we assumed that the insufficiency was caused by an alteration of the right ventricular geometry. After 1 week, the valve insufficiency regressed to a minimal degree. In pediatric heart transplant patients with a high donor-to-recipient weight ratio, the outlined complication may occur. If other reasons for right ventricular heart failure can be ruled out, this entity is most likely caused by an acute and transient alteration of the right ventricular geometry that may disappear over time.
在小儿心脏移植中，供体器官的大小是器官分配的重要标准。过大的供体心脏通常被接受且效果良好，但也有一些与供体-受体比例过高相关的并发症被描述过。我们的患者因扩张型心肌病导致的进行性心力衰竭接受了移植。供体与受体的体重比为3（供体体重65千克，受体体重22千克）。关胸前行术中超声心动图检查显示心脏功能良好，无三尖瓣反流，中心静脉压正常。关胸后，中心静脉压大幅升高，超声心动图显示严重的三尖瓣关闭不全。由于排除了右心室功能障碍的其他原因，即心肌缺血、肺动脉高压和排斥反应，我们推测这种关闭不全是由右心室几何形状改变引起的。1周后，瓣膜关闭不全程度减轻至最小。在供体与受体体重比高的小儿心脏移植患者中，可能会出现上述并发症。如果能排除右心室心力衰竭的其他原因，这种情况很可能是由右心室几何形状的急性和短暂改变引起的，这种改变可能会随着时间消失。
