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Chest radiography in infant cardiac allotransplantation
F B Toomey1, L L Bailey, R D Bui
1Department of Radiology, Loma Linda University Medical Center, CA 92354.
Insights
Radiographs of infants after heart transplants reveal distinct cardiac contours and slight cardiomegaly. Increasing cardiomegaly may indicate early rejection, aiding in timely intervention for pediatric heart transplant recipients.
Area of Science:
- Pediatric cardiology
- Cardiovascular surgery
- Medical imaging
Background:
- Heart transplantation in infants presents unique challenges.
- Radiographic findings in pediatric heart transplant recipients require specific interpretation.
- Early detection of complications like rejection and infection is crucial for patient survival.
Purpose of the Study:
- To describe the radiographic appearance of the chest in infants following heart transplantation.
- To correlate radiographic findings with clinical events, including acute rejection and gastrointestinal infections.
- To assess the prognostic value of serial chest radiographs in this population.
Main Methods:
- Retrospective review of chest radiographs from seven infant heart transplant recipients (1985-1987).
- Analysis of pre-operative, immediate post-operative, and follow-up radiographs.
- Correlation with clinical data, echocardiography, electrocardiography (ECG), and upper gastrointestinal studies.
Main Results:
- Five of seven infants survived the study period.
- Radiographs showed an unusual cardiac contour and mild cardiomegaly post-transplant.
- Increasing cardiomegaly was associated with documented acute rejection.
- Gastrointestinal rotavirus infections were noted in four patients, with dilated small-bowel folds on upper GI studies.
Conclusions:
- Chest radiographs in infant heart transplant recipients display characteristic cardiac contours and potential for cardiomegaly.
- Serial monitoring for increasing cardiomegaly can serve as an early indicator of cardiac allograft rejection.
- Dilated proximal small-bowel folds may be associated with infections secondary to immunosuppression, though their significance requires further investigation.
Abstract:
Heart transplants were performed in seven infants at Loma Linda University Medical Center from 1985 to 1987. Five of these seven patients survived. In this report, the radiographic appearance of the chest is presented before surgery, immediately after surgery, and during a documented episode of rejection. The most current available chest radiograph is also presented. Acute rejection was confirmed by clinical, echocardiographic, and ECG findings. The only pulmonary infection encountered was mycoplasma pneumonitis. Four patients developed gastrointestinal rotavirus infections and were shown to have dilated proximal small-bowel folds on upper gastrointestinal studies. At the time of this writing, the prognosis for the five surviving infants is good. We conclude that the radiographs of infants who have received heart transplants show an unusual cardiac contour and slight cardiomegaly. Increasing cardiomegaly can alert one to early rejection. Prominent folds in the small bowel are of uncertain origin and significance, but they may be related to infection resulting from immunosuppression.