同种异位心脏移植的超声心动图研究

Evaluation of echocardiographic characteristics on heterotopic heart transplantation

目的研究异位心脏移植的超声心动图特点，评价心功能及早期排异反应。方法对5例接受异位心脏移植的患者，应用超声心动图分别进行术前、术中、术后及随访观测。观察原位受体心脏（受体）和异位供体心脏（供体）的吻合关系及房室大小、左室射血分数（LVEF）、室壁运动、瓣膜功能、肺动脉压变化、胸腔积液及心包积液情况。结果5例均为冠心病晚期患者，心功能Ⅲ～Ⅳ级，左室射血分数平均（24．4±4．1）％。所有患者均有室壁瘤，并接受冠状动脉旁路移植术。部分患者接受二尖瓣成形、室壁瘤切除及千细胞移植。供体均置于右侧胸腔。4例为左心辅助，1例为全心辅助。超声评价术前受体的心功能减低，均发现异常室壁运动及室壁瘤。术中经食管超声能够评价复跳后即刻心功能、吻合口、瓣膜以及心脏排气的情况。超声显示术后供体和受体心功能均逐渐恢复；在术后随访6个月至1年中，受体心功能较术前不同程度提高。主要的排异反应为少量的胸腔及心包积液。结论异位心脏移植超声心动图具有鲜明的特征性，在术前受体评价、术中监测及术后随访中都具有重要的临床价值。

Objective To study the characteristics of heterotopic heart transplantation by echocardiography and evaluate the heart function and acute rejection. Methods Five male 49-61 years old patients with heterotopic heart transplantation were studied using echocardiography pre-, intra-, post-operation and at follow-up. The anastomoses of great vessels of recipient with donor heart,chamber size,left ventricular wall thickness with wall motion,left ventricular ejection fraction （LVEF）, valvular function, pulmonary artery pressure, pericardial and pleural effusion were observed. Results All patients were end-stage coronary artery disease with NYHA class of Ⅲ-Ⅳ, mean LVEF of （24.4 ±4.1 ）%. All had left ventricular aneurism with wall motion abnormality. All patients received heterotopic heart transplantation with coronary artery bypass grafting. Some patients received mitral valvuloplasty,ventricular aneurysmectomy and stem cell transplantation simultaneously. During the operation, intra-operation transesophageal echocardiography was used to monitor and evaluate the surgical procedure with chamber sizes,anastomoses,native with donor heart ventricular and valvular function,and air bubble in chambers. The cardiac functions of donor heart backed to normal post-operation, while the functions of recipient heart were increased gradually. All patients survived in 6 months and one year follow-up, with significantly improved functions of heart in situ [LVEF（44. 0 ±15.6） %. The main reject reaction was small pericardial perfusion and pleural effusion. Conclusions Heterotopic heart transplantation has distinctive characteristics with echocardiography study,which is also an important technique in evaluation at pre-,intra-,post-operation and also at follow-up.