同种异体原位心脏移植2例报告

Report of two cases of orthotopic cardiac transplantation

目的 总结 2例原位心脏移植成功的治疗经验 ,探讨手术方式及术后围手术期处理。方法 2 0 0 3年5月和 2 0 0 3年 12月先后为 2例终末期心肌病患者施行原位心脏移植手术。术后免疫抑制剂应用“环孢素 A+强的松+骁息”三联疗法。结果 2例手术均获成功 ,术后无并发症发生 ,心功能良好 ,生活质量好。结论 经典法原位心脏移植操作方便、缝合牢固确实 ,但存在术后心房偏大的不足 ;围手术期处理中应重视右心功能不全、肾功能不全的防治和胃肠道营养的应用。

Objective To sum up the clinic experience of orthotopic cardiac transplantation in two cases,and to investigate some important questions about selection of operative procedures and perioperative management such as:prevention and treatment of right heart failure and acute renal failure,and nutritional support.Methods Orthotopic cardiac transplantation was performed on two patients with endstage cardiomyopathy in May 2003 and December 2003.Postoperative immunosuppressive therapy was Cyclosporin A,Cellcept and Predisone.Results All patients survived operation and recovered well.No postoperative morbity occurred.They are all having good heart functions now and living well.Conclusion Classic orthotopic cardiac operative procedure is relatively easier to be performed,and the outcome of suture is reliable,but the drawback of large atrial cavity after operation is obvious.Special care should be paid on the following factors in perioperative management such as:prevention and treatment of right heart failure and acute renal failure,and nutritional support.