供受体体重不匹配儿童心脏移植的围手术期处理

Perioperative management of pediatric orthotopic heart transplantation with donor-recipient weight mismatch

目的 总结 1例 13岁终末期扩张型心肌病儿童施行原位心脏移植术 ,因供受体体重不匹配所带来的围手术期有关问题的处理经验。方法 供体 2 8岁 ,体重 63kg ,主动脉直径 2 .8cm。受体 13岁 ,体重37kg。主动脉直径 1.7cm。术中采用主动脉成形处理供受体主动脉直径不匹配。术后采用大剂量血管扩张剂控制成人心脏移植到儿童所带来的高心输出量并发症 ,并针对儿童代谢快的特点调整免疫抑制剂的用量。结果 术后血流动力学稳定。第 12天心肌活检病理学检查无排斥反应 ,31d出院 ,随访 18个月 ,心功能良好。结论 扩张型心肌病的儿童 ,可采用成人供心施行心脏移植术。

Objective To summarize the experience on perioperative management of a donor recipient mismatched orthotopic heart transplantation on a 13 year old child with late dilated cardiomyopathy. Methods The donor was at the age of 28 and with weight of 63 kg and ascending aorta diameter of 2.8 cm. The recipient was 13 years old and his weight was 37 kg and the diameter of his ascending aorta was 1.7 cm. Aortoplasty was performed for the mismatch of donor recipient ascending aorta diameters. After the operation, a large dose of vasodilators (nitroglycerin and prostaglandin E1) were administered to alleviate the high cardiac output complication resulting from adult heart transplanted to child. The dose of immunosuppressant was adjusted in accordance with the features of pediatric metabolism. Results Postoperative hemodynamics of the child was stable. No rejection was found with endomyocardial biopsy on the 12th d. The child recovered well and discharged on the 31st d after the transplantation. The function of heart graft was good during the 18 months of follow up. Conclusion Our operation indicates that adult heart could be transplanted to children suffering from dilated cardiomyopathy.