同种原位心脏移植二例

Orthotopic heart transplantation--a report of two cases

本院于１９９２年７月５日和１１日在６天内连续为２例晚期扩张型心肌病患者施行同种原位心脏移植术。２例患者术后已度过１年３个月，现健康状况良好。

Abstract Two male patients, 55 and 38 years of age, in their end stage of dilated cardiomyopathy received orthotopic heart transplantation on July 5th and 11th, 1992, respectively. In case 1, because of severe cardiac dysfunction, his heart was arrested soon after sternotomy. He was rescued by emergent cardiopulomonary bypass. To match with the giant atrial circumference of the recipient, we reserved the whole posterior wall of the donor's left atrium as a flap, and used converging suture technique for both cases. In case 2, we had to additionally use 'Sandwich' method to plicate each of his inferior artial wall. The cross-clamping time of the aorta was 45 and 55 minutes respectively. Since the patients were only cooled down to 32℃ and myocardium was well protected, the extracorporeal circulation time were shortened to 78 and 80 minutes respectively. Because both patients had long term preoperative heart failure, which caused high pulmonary vascular resistance--6.6 and 7.1 Wood units, their CVP rose up to 18 and 28cm H2O around ten hours after operation respoctively, and mild systemic hypotension occurred. For case 1, 8μg / kg ·m of regitine was used.Four days later, he recovered from right heart dysfunction. For case 2, 10μg/kg· m of regitine and 3μg / kg ·m of nitroglycerin were used in combination. His CVP decreased to normal five days later. Both cases are treated with cyclosporine A,azathioprine and prednisone as routine post-operative immunosuppressive therapy.Clinical manifestation and echo-guided endomyocardial biopsy proved moderate degree of acute rejection on day 18 and 39 in case 1, and on day 10 in case 2, which was effectively controlled by methylprednisolone (1g×3days) as a 'pulse therapy' .There has been no rejection thereafter.One year after the transplantation, their coronary angiograms were normal, and no neoplasm was found by clinical examination and CT scanning. Both of them have been well and returned to their normal lives more than one year after the operations.