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[The pediatric heart transplant. Its evolution and early postoperative complications]
C Villaizán1, V Alzina, J Román
1Departamento de Pediatría, Facultad de Medicina, Universidad de Navarra, Pamplona.
Insights
Pediatric heart transplantation offers a durable solution for severe heart conditions in children. Most recipients experience excellent quality of life post-transplant, with manageable complications.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Immunology
Background:
- Cardiac transplantation is a viable treatment for refractory heart diseases in both adults and pediatric patients.
- Congenital heart defects and cardiomyopathies are primary indications for pediatric heart transplantation.
Purpose of the Study:
- To evaluate the outcomes of cardiac transplantation in pediatric patients.
- To assess the efficacy of immunosuppressive regimens and management of complications.
Main Methods:
- Seven children (ages 2 months to 13 years) underwent heart transplantation between 1987-1992 for various conditions including dilated and hypertrophic cardiomyopathy, and cardiac fibroma.
- Immunosuppression included cyclosporine, azathioprine, and glucocorticoids.
- Follow-up ranged from 15 months to 5 years and 9 months.
Main Results:
- Two patients experienced acute rejection, successfully managed with high-dose glucocorticoids.
- Two patients developed severe infections (Staphylococcus aureus sepsis) but had successful outcomes with antibiotic treatment.
- Mortality occurred in two patients: one early post-operative death and one late death due to myelodysplastic syndrome.
- Five patients are currently asymptomatic with normal growth, and one remains on glucocorticoids.
Conclusions:
- Pediatric heart transplantation is a durable therapy for congenital and myopathic heart disease.
- The procedure offers an excellent quality of life for infants and children with severe cardiac conditions.
Background:
Cardiac transplantation is an acceptable therapeutic alternative for cardiac diseases refractory to other forms of management in adults as well as in infants and children.
Methods:
Between 1987-1992 7 children (4 girls and 3 boys) underwent cardiac transplantation: four with dilated cardiomyopathy, one with cardiac fibroma and two with hypertrophic cardiomyopathy. Age at transplantation ranged from 2 months to 13 years and 5 months, with a follow-up ranging from 15 months to 5 years and 9 months. Prophylaxis of acute rejection consisted of cyclosporine, azathioprine and glucocorticoids.
Results:
Two patients presented acute rejection three weeks after cardiac transplantation, with a good response to high dose glucocorticoids. Two patients developed severe infection (sepsis by Staphylococcus aureus) with successful outcome after antibiotic treatment. One patient died in the early postoperative period and other after 4 years 11 months postransplantation because myelodysplastic syndrome. At present only one case is receiving glucocorticoids in immunoprophylaxis. The status is asymptomatic in the other 5 patients with a normal height-weight development.
Conclusions:
Heart transplantation provides durable therapy for congenital and myopathic heart disease in infants and children with an excellent quality of life.