Heart transplantation and the batista operation for children with refractory heart failure
Journal
Japanese Circulation Journal
Journal Volume
65
Journal Issue
4
Pages
289-293
Date Issued
2001
Author(s)
Lin J.-H.
Chen Y.-S.
Jou N.-K.
Lue H.-C.
Chu S.-H.
Abstract
Medically refractory heart failure may be present in children with cardiomyopathy (CMP) or complex congenital heart disease (CHD). In adults, the surgical management of this condition is either heart transplantation or the Batista operation. From March 1995 to January 2000, a total of 6 children, aged from 1 to 16 years, with medically refractory heart failure associated with CMP or complex CHD underwent cardiac transplantation and one of them also had the Batista operation as a bridge to transplantation. One of the 6 patients died of intractable sepsis 17 days after the operation, but the other 5 were discharged with satisfactory hemodynamics. Immunosuppressive agents, including azathioprine, cyclosporin or FK-506, were given. One patient experienced moderate acute rejection, but it was controlled by FK-506, OKT-3 and solumedrol. However, another suffered from lymphoproliferative disease 8 months after transplant, but it was controlled by intravenous immunoglubulin, αinterferon and acyclovir. Cardiac function during serial follow-up (range, 1 month to 5 years) revealed normal systolic and diastolic function and none received any anticongestive medications. Almost all patients received an oversized donor heart. The left ventricle (LV) mass was remodeled, initially as an decrease and later as an increase. The patient who underwent the Batista operation was discharged I month after the operation with an increased LV ejection fraction (from 10% to 22%). She was successfully bridged to heart transplantation 7 months after the Batista operation. The results of cardiac transplantation in growing children are satisfactory and remain the mainstay of surgical treatment for medically refractory heart failure in these patients. However, with a shortage of donor hearts, the Batista operation may be adopted as a bridge to heart transplant with a fair response.
SDGs
Other Subjects
aciclovir; alpha interferon; azathioprine; cyclosporin; immunoglobulin; methylprednisolone sodium succinate; mycophenolic acid 2 morpholinoethyl ester; OKT 3; prednisolone; tacrolimus; thymocyte antibody; adolescent; article; cardiomyopathy; child; clinical article; congenital heart disease; echocardiography; female; follow up; graft rejection; heart failure; heart left ventricle ejection fraction; heart left ventricle mass; heart muscle biopsy; heart transplantation; human; lymphoproliferative disease; male; surgical technique; Adolescent; Cardiomyopathy, Dilated; Cardiomyopathy, Restrictive; Cardiovascular Agents; Child; Child, Preschool; Drug Resistance; Female; Follow-Up Studies; Graft Rejection; Heart Defects, Congenital; Heart Failure, Congestive; Heart Function Tests; Heart Transplantation; Heart Ventricles; Humans; Immunosuppressive Agents; Male; Organ Size; Postoperative Complications; Severity of Illness Index; Survival Rate; Treatment Outcome; Ventricular Remodeling
Type
journal article