Loker J, Darragh R, Ensing G, Caldwell R
University Medical Center, Riley Hospital for Children, Indianapolis, IN 46202.
J Heart Lung Transplant. 1994 Nov-Dec;13(6):1014-8.
Eleven children who received transplants at less than 2 years of age underwent 59 echocardiograms at the time of endomyocardial biopsy for the assessment of the ability of echocardiography to predict acute rejection in the infant heart transplant recipient. Two patients died of acute rejection and autopsy findings were compared with premortum echocardiograms. Biopsy specimens were graded as no rejection (n = 46), mild rejection (cellular infiltrate, n = 5), or moderate-severe rejection (myocyte necrosis/edema, n = 8). Echocardiographic indexes measured included the following: left ventricular mass, left ventricular volume, ejection fraction, heart rate, and peak rate of posterior wall thinning. Compared with controls, patients during mild rejection had slower posterior wall diastolic thinning (p < 0.01). No significant change was noted in left ventricular mass until endomyocardial biopsy specimens showed severe rejection. No significant changes were noted in heart rate or ejection fraction in any of the groups. In conclusion, decrease in the peak rate of posterior wall diastolic thinning may be a sensitive indicator of acute rejection in the infant heart transplant recipient.
11名在2岁以下接受移植的儿童在进行心内膜心肌活检时接受了59次超声心动图检查，以评估超声心动图预测婴儿心脏移植受者急性排斥反应的能力。2名患者死于急性排斥反应，并将尸检结果与死前超声心动图进行了比较。活检标本分为无排斥反应（n = 46）、轻度排斥反应（细胞浸润，n = 5）或中度至重度排斥反应（心肌细胞坏死/水肿，n = 8）。测量的超声心动图指标包括：左心室质量、左心室容积、射血分数、心率和后壁变薄峰值速率。与对照组相比，轻度排斥反应患者的后壁舒张期变薄较慢（p < 0.01）。在心内膜心肌活检标本显示严重排斥反应之前，左心室质量没有显著变化。任何一组的心率或射血分数均无显著变化。总之，后壁舒张期变薄峰值速率降低可能是婴儿心脏移植受者急性排斥反应的一个敏感指标。
