Cochrane A D, Adams D H, Radley-Smith R, Khaghani A, Yacoub M H
Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
J Heart Lung Transplant. 1995 Mar-Apr;14(2):296-301.
The presence of significant elevation of pulmonary vascular resistance is a major risk factor for death after orthotopic heart transplantation. The choice of procedure for the pediatric patient remains contentious.
We report three pediatric patients with pulmonary hypertension and raised pulmonary resistance, including two infants, in whom heterotopic transplantation was performed with smaller donor hearts. The hearts were anastomosed to provide left ventricular support alone because predominant left ventricular failure was present, the pulmonary resistance was expected to fall gradually after surgery, and we wished to avoid the potential problems of a pulmonary conduit associated with growth and possible reoperation.
The clinical results have been satisfactory in all three patients, who were well and without symptoms. No pulmonary compromise was observed in the smaller thoracic cavity of the two infants. The transpulmonary gradient fell in all three patients, although this reduction was not immediate.
This technique in carefully selected recipients can allow safer transplantation in pediatric patients with elevated pulmonary resistance, can increase the donor pool by allowing use of smaller hearts and nonideal donors, and may reduce the mortality on the transplant waiting list by providing earlier transplantation.
肺血管阻力显著升高是原位心脏移植术后死亡的主要危险因素。小儿患者的手术方式选择仍存在争议。
我们报告了3例患有肺动脉高压和肺阻力升高的小儿患者，其中包括2例婴儿，对他们进行了使用较小供体心脏的异位移植。由于主要存在左心室衰竭，预计术后肺阻力会逐渐下降，且我们希望避免与生长及可能再次手术相关的肺导管潜在问题，因此将心脏吻合仅提供左心室支持。
所有3例患者的临床结果均令人满意，他们情况良好且无症状。在2例婴儿较小的胸腔内未观察到肺功能受损。所有3例患者的跨肺压差均下降，尽管这种下降并非即刻出现。
在精心挑选的受者中，这项技术可使肺阻力升高的小儿患者进行更安全的移植，通过允许使用较小的心脏和非理想供体来增加供体库，并可能通过更早进行移植来降低移植等待名单上的死亡率。
