婴儿心脏移植术后一年随访

Postoperative one year follow-up for orthotopic cardic transplantation in an infant

目的对1例原位心脏移植术后已1年的患儿做心脏结构、形态、功能、血流动力学指标及排斥反应等检查随访，并进行综合评价。方法男性患儿术时8个月龄，心脏移植术后采用实时三维超声诊断仪、心电图、X线胸片、血环孢素A（CsA）浓度、血细胞计数和分类、血肝肾功生化及外周血T淋巴细胞亚群检查，同时结合临床观察等综合方法，对移植心脏进行综合评价。结果患儿顺利渡过手术及术后围术期，未发生急性排斥反应、感染及其他并发症，现已存活1年，生活质量良好，心功能Ⅰ级。体重10kg，身高83．5cm，足长12．5cm，头围45cm，胸围49cm。超声心动图示左房、左室、右房、右室内径分别为22．4mm、29．0mm、30．8m、11．0mm，左室后壁心肌厚度6．7mm，LVEF 0．65，各组瓣膜均未探及明显反流。术后不同时期CsA的应用按照测定的全血谷浓度G，及服药后2h峰值浓度C2进行调整，术后1个月内将CsA谷值（G0）维持在0．1664～0．2080μmol／L，2～3个月匕维持在0．1248～0．1664μmol／L，4～6个月G0维持在0．0832～0．1248μmol／L，7～12个月G0维持在0．0666～0．0998μmol／L。未见药物不良反应。结论婴儿心脏移植在我国尚处于初步阶段，在移植后早期免疫抑制剂应用方面及排异反应监测方面，还有很多具体问题需要进一步总结探讨，因此术后长期随访并总结规律是必要的。

Objective To perform one year follow-up for one case of orthotopic heart transplan tation, including cardiac structure, morphology, function, hemodynamics, immune rejection and com prehensive evaluation. Methods The male child was eight months old at operation. After heart transplantation, real-time three-dimensional ultrasound scanner, ECG, X-ray, blood cyclosporine A （CsA） concentration, blood count and classification biochemical blood liver and kidney function, peripheral blood T cell subsets examination, and the clinical observation were integrated as approach right for evaluation of the heart transplant. Results This child recovered well during perioperative periods, without acute rejection, infection or other complications. He was viable with good quality of life and class Ⅰ of heart function. He was 10kg in weight, 83.5 cm in height, 12. 5 cm in foot length, 45 cm in head circumference, and 49 cm in brassieres during follow up. Echocardiography indicated that the diameters of left atrium, left ventricle, right atrial and ventricular dimension were 22. 4 mm, 29. 0mm, 30. 8 mm. 11.0 mm, respectively. The thickness of left ventricular wall was 6. 7 mm, LVEF 0. 65, without obvious reflux of valves. The administration of cyclosporine A was adjusted in accordance with its blood concentrations G0 and the peak concentration C2. The postoperative G0 was maintained at 0. 166 4 - 0. 208 0 mol/L for the first one month, （I. 124 8 - 0. 166 4 mol/L for the 2 - 3 months, 0. 083 2 - 0. 124 8 mol/L for the 4~6 months, and 0. 066 6 - 0. 099 8 mol/L for the 7 - 12 months, without side effects. Conclusions Infant heart transplantation in China is still at a preliminary stage. With regard to the early application of immunosuppressant and monitoring of rejection reaction, there are many specific issues warranting further study. Thus, a long-term follow-up to outline the rules is necessary.