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[Cardiac transplantation in the infant and young child. Preliminary results]
J Le Bidois1, P Vouhé, J Kachaner
1Département de pédiatrie, hôpital Necker/Enfants Malades, Paris.
Insights
Pediatric heart transplantation offers a life-saving option for children with severe heart conditions. This study shows successful outcomes in 6 out of 9 young patients, highlighting the potential of this complex procedure.
Area of Science:
- Pediatric Cardiology
- Cardiothoracic Surgery
- Transplantation Immunology
Context:
- Heart transplantation in children presents unique challenges.
- Congenital heart disease and dilated cardiomyopathy often leave few treatment options.
- This study was conducted at a major European pediatric cardiac center.
Purpose:
- To evaluate the feasibility and early outcomes of pediatric heart transplantation.
- To assess the management of immunosuppression and graft rejection in young recipients.
- To determine the survival rates and quality of life post-transplantation.
Summary:
- Nine children, including six infants, underwent heart transplantation between 1987 and 1988.
- Indications included end-stage congenital heart disease and refractory dilated cardiomyopathy.
- Three perioperative deaths occurred; six children survived with long-term immunosuppression (cyclosporine, azathioprine).
- Graft rejection was managed clinically, with two biopsy-confirmed episodes in one patient.
Impact:
- Pediatric heart transplantation can be a viable treatment for critically ill children.
- Successful transplantation significantly improves survival and quality of life.
- Effective immunosuppressive strategies are crucial for long-term graft survival.
Abstract:
Between January and December, 1987, a programme of heart transplantation in paediatrics was designed and carried out in 9 children by the medical and surgical teams of the Necker/Enfants Malades-Laënnec hospitals group, Paris. Six of the patients were infants of less than 2 years (4 were under one year), and the oldest child was 10 years old. All patients seemed to be condemned to an early death either because their congenital heart disease was beyond the resources of conventional surgery (6 cases) or because their dilated cardiomyopathy was refractory to all medical treatments. Three children died at the end of the operation or a few days afterwards, due to poor quality graft (1 case), fulminating bacterial superinfection (1 case) or intractable pulmonary hypertension (1 case). The remaining 6 children are now living as normally as possible in their respective families. The long-term immunosuppressive treatment consists of cyclosporine and azathrioprine; corticosteroids are only used at the very beginning of treatment or in case of graft rejection. Only two episodes of rejection, confirmed by endomyocardial biopsy, were observed in the same patient during the first postoperative month. Biopsy was never performed systematically in order to spare the patient's vein, and the diagnosis of rejection was suspected on clinical grounds.(ABSTRACT TRUNCATED AT 250 WORDS)