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A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation
Published on: April 27, 2019
Ventricular volume growth after cardiac transplantation in infants and children
V R Zales1, K L Wright, A J Muster
1Division of Cardiology, Children's Memorial Hospital, Chicago, IL 60614.
Insights
Pediatric cardiac transplant recipients show normal heart function and ventricular growth. This study confirms that cardiac transplantation supports healthy left ventricular volume expansion in children.
Area of Science:
- Pediatric Cardiology
- Cardiac Transplantation
- Pediatric Cardiac Surgery
Background:
- Pediatric cardiac transplantation survival rates are improving.
- Limited data exists on ventricular growth and cardiac function post-transplant in pediatric patients.
Purpose of the Study:
- To evaluate hemodynamics, left ventricular (LV) volume, and ventricular function serially in pediatric cardiac transplant recipients.
- To assess cardiac function and growth in infants and children after heart transplantation.
Main Methods:
- Serial cardiac catheterizations were performed annually up to 3 years post-transplant.
- Hemodynamic parameters, LV volume, and ejection fraction were measured.
- Endomyocardial biopsies were conducted to assess for chronic rejection.
Main Results:
- Left ventricular end-diastolic volume increased with patient growth, maintaining predicted values.
- Ejection fraction remained within normal predicted ranges.
- No evidence of chronic rejection or accelerated coronary artery atherosclerosis was found.
Conclusions:
- Pediatric cardiac transplant recipients exhibit normal hemodynamics and LV function.
- Cardiac transplantation facilitates normal LV volume growth, even with immunosuppression and denervation.
Background:
Intermediate-term survival after pediatric cardiac transplantation continues to improve. However, little is known about cardiac function and especially ventricular growth in young patients after cardiac transplantation. The purpose of this study was to evaluate serially the hemodynamics, left ventricular (LV) volume, and ventricular function after cardiac transplantation in infants and children.
Methods And Results:
Indications for cardiac transplantation were dilated cardiomyopathy (eight patients), hypoplastic left heart syndrome (six patients), and postoperative structural congenital heart disease (three patients). The age at time of transplant ranged from 7 days to 15 years (median, 3.5 years). The mean follow-up was 30.3 months (range, 13-46 months). Serial annual cardiac catheterizations were performed 1 year (17), 2 years (15), and 3 years (seven) after transplant. Measurements included right and left heart pressures, cardiac index, and LV volume and ejection fraction (Lange). Cumulative results (expressed as mean +/- SD) were pulmonary artery pressure, 14.9 +/- 3.2 mm Hg; LV end-diastolic pressure, 7.7 +/- 2.6 mm Hg; cardiac index, 3.5 +/- 0.52 l/min.m-2; and pulmonary vascular resistance, 2.02 +/- 0.76 units/m2. LV end-diastolic volume increased as patients grew, so that left ventricular end-diastolic volume remained 90 +/- 14% of that predicted for body surface area. The ejection fraction was 99 +/- 6% of that predicted. There was no evidence of chronic rejection by endomyocardial biopsy. No accelerated coronary artery atherosclerosis was identified.
Conclusions:
Serial studies in these young patients demonstrate normal hemodynamics and LV function after cardiac transplantation. Cardiac transplantation is associated with normal LV volume growth despite immunosuppression and denervation.
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