Gallardo A, Anguita M, Franco M, Giménez D, Torres F, Ciudad M, López-Granados A, Mesa D, Arizón J M, Concha M
Servicio de Cardiología, Hospital Reina Sofía, Córdoba.
Rev Esp Cardiol. 1994 Sep;47(9):604-8.
Brain death causes myocardial impairment by some mechanisms not yet well understood. The aim of this work was to assess the echocardiographic features found in these patients and their implication in donor selection for heart transplantation.
With this aim, we have studied 38 consecutive patients with brain death assessed as possible donors for heart transplant in our hospital in the last 3 years. Age was 23 +/- 13 years; 77% were male. No history of cardiac disease was present in any patient. An adequate transthoracic echocardiogram was obtained in 74% of patients; transesophageal view was used in the remaining 26%.
Echocardiogram was strictly normal in only 14 patients (37%). Mild valvular alterations were found in 5 patients (13%); a dilated aortic root in 1 (3%); moderate concentric left ventricular hypertrophy in 5 (14%); mild pericardial effusion in 1 (3%); mild septal hypokinesia with normal left ventricular ejection fraction in 4 (10%); abnormal left ventricular diastolic function in 7 (18%); and diffuse hypokinesia with ejection fraction less than 60% in 14 (37%). In 7 patients (18%) ejection fraction was lower than 40% (one of them was cocaine-addict). Mean ejection fraction was 59 +/- 15% (23 to 83%). Only 2 of the 19 (10%) donor hearts implanted in our hospital showed early dysfunction after transplant, but no relation to pretransplant ejection fraction was found. Ejection fraction increased from 62% pretransplant to 73% at one week after transplant in the other 17 cases.
Brain death commonly causes alterations of left ventricular function, and this impairment is severe in almost 20% of cases. These echocardiographic features must be known when selection of donors for heart transplantation is concerned.
脑死亡通过一些尚未完全明确的机制导致心肌损伤。本研究旨在评估这些患者的超声心动图特征及其在心脏移植供体选择中的意义。
为此，我们研究了过去3年在我院被评估为可能的心脏移植供体的38例连续脑死亡患者。年龄为23±13岁；77%为男性。所有患者均无心脏病史。74%的患者获得了充分的经胸超声心动图检查；其余26%采用了经食管超声心动图检查。
仅14例患者（37%）的超声心动图完全正常。5例患者（13%）发现轻度瓣膜改变；1例（3%）主动脉根部扩张；5例（14%）出现中度同心性左心室肥厚；1例（3%）有轻度心包积液；4例（10%）出现轻度室间隔运动减弱但左心室射血分数正常；7例（18%）左心室舒张功能异常；14例（37%）出现弥漫性运动减弱且射血分数低于60%。7例患者（18%）的射血分数低于40%（其中1例为可卡因成瘾者）。平均射血分数为59±15%（23%至83%）。在我院植入的19例供体心脏中，只有2例（10%）在移植后早期出现功能障碍，但未发现与移植前射血分数有关。在其他17例病例中，射血分数从移植前的62%增加到移植后1周时的73%。
脑死亡常导致左心室功能改变，近20%的病例这种损伤较为严重。在考虑心脏移植供体选择时，必须了解这些超声心动图特征。
