同种异体原位心脏移植成功3例报告

Clinical Application of Orthotopic Heart Transplantation on Three Successful Cases Report

目的:总结分析3例同种异体原位心脏移植术的临床经验。方法:采用Shumway&Stanford方法对3例终末期扩张型心肌病病人行同种异体原位心脏移植术。其中1例伴有严重糖尿病和中度肺动脉高压,术前心跳骤停心肺复苏成功;1例极度肥胖,体重108kg(身高172cm);1例62岁高龄伴肾功能不全和中度肺动脉高压。供体均为脑死亡者,供心保护采用4℃改良StThomas液;术后免疫抑制治疗采用环孢素A、骁悉、强的松三联治疗,根据血环孢素浓度及心内膜活检调整环孢素A用量。结果:3例均康复,未发生术后超急性或急性排斥反应。例2术后出现一过性右心功能不全,经大量利尿和无创通气治疗,48h后完全恢复;例3术后并发急性肾功能衰竭和肺部感染,经连续肾脏替代(CRRT)和调整抗生素治疗痊愈。病人心功能均恢复正常。例1需长期胰岛素治疗糖尿病。3例均完全过上了正常人的生活,2例已恢复手术前工作。结论:同种异体原位心脏移植是治疗终末期心脏病的有效方法。

Objective: To review the clinical experience of successful orthotopic heart transplantation for three patients with end stage dilated cardiomyopathy. Methods: From August 2001 to April 2002, 3 patients with dilated cardiomyopathy underwent orthotopic heart transplantation. The first case was a 51 years old woman with the addition of moderate pulmonary artery hypertension and diabetes. She had heart arrest 22nd days before operation and underwent cardiopulmonary resuscitation. The second case is a man of 26 years with excessive obesity (body weight 108 kg and 172 cm high). The third is a 62 years old male with renal insufficiency. Three patients underwent Shumway&Stanford orthotopic heart transplantation. Donor hearts were preserved by modified St Thomas solution. The triple immunosuppressive agents treatment of cyclosporine A, MFF, and prednisone were applied after transplantation. The dosage of cyclosporine A was adjusted according to its concentration in blood. Results: All patients survived the operation. There is no severe rejective reacton. One had right heart dysfunction and another had acute renal failure who need continue renal replacment therapy(CRRT). The cardiac function, clinical condition, quality of life after transplantation were significantly improved.Conclusion: Heart transplantation is one of the most effective treatments for all irreversible end stage heart disease.