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A Novel Method of Chest Wall Reconstruction Succeeding Pediatric Heart Transplantation Donor-recipient Size Mismatch:
Malcolm Lesavoy1, Jade March2, Ian Roy1
1From the Department of Plastic Surgery, University of California, Los Angeles, Los Angeles, CA.
Insights
Pediatric heart transplantation in infants can face size mismatch challenges. A modified thoracoplasty helped close the chest wall after a large donor heart transplant in a 23-month-old, ensuring long-term patient vitality.
Area of Science:
- Pediatric cardiac surgery
- Thoracic surgery
- Transplantation medicine
Background:
- Pediatric heart transplantation is complex, often complicated by donor-recipient size discrepancies.
- Infants undergoing heart transplantation may require surgical modifications for chest wall closure.
- Nonischemic dilated cardiomyopathy is a significant indication for pediatric heart transplantation.
Observation:
- A 23-month-old infant received an orthotopic heart transplant for nonischemic dilated cardiomyopathy.
- The donor heart was notably larger than the infant recipient's thoracic cavity.
- A modified thoracoplasty was performed to facilitate chest wall closure post-transplant.
Findings:
- The modified thoracoplasty successfully addressed the size mismatch, enabling chest closure.
- This surgical intervention allowed for the successful transplantation of a larger-than-ideal donor heart.
- The report details surgical techniques applicable to similar pediatric cases.
Implications:
- This case highlights the feasibility of managing significant donor-recipient size discrepancies in pediatric heart transplantation.
- Modified thoracoplasty offers a viable solution for chest wall closure in infant heart recipients with large grafts.
- Long-term follow-up of 25 years provides valuable insights into the outcomes of such complex pediatric cardiac procedures.
Abstract:
Pediatric heart transplantation can present with many obstacles, including size mismatch of the donor heart with the thoracic cavity of the recipient. For the patient to have vitality, they may need to have surgical interventions to address these conditions. We investigate the case of a 23-month-old infant who underwent orthotopic heart transplantation for nonischemic dilated cardiomyopathy. Given the large size of the donor heart relative to the infant, a subsequent modified thoracoplasty was performed to allow for chest wall closure. This report provides potential surgical techniques that can be taken and follows the patient for a 25-year time span.
