Three cases of orthotopic heart transplantation surviving more than 10 years / 中华器官移植杂志

ABSTRACT

Objective To summarize the experience of long-term survival of the patients under- going orthotopic heart transplantation.Methods Heart transplantation was performed on 2 cases of dilated cardiomyopathy and one case of Keshan disease.Before operation,pulmonary artery pressure was 42-53 mm Hg(5.60-7.07 kPa)and pulmonary vascular resistance 5.6-7.0 wood.The body weight difference between donors and receptors was 10%-15%.There were three same antigens in HLA zygosity experiment for all of three patients.Two cases were subjected to standard heart trans- plantation and one case to whole heart transplantation.All the atriums and big vessels were sutured by evting suture method.Cyclosporin A,azathioprine and corticosteroid were used to prevent patients from rejection.Results Survival time of 3 patients was 13 years and 10 months,12 years and 10 years and 3 months.Heart functions of three patients were NYHAⅠand all of 3 patients are living and working commonly.Six,3 and 1 rejection(s)occurred in 3 patients respectively and cured by appro- priate treatment.Electrocardiogram revealed that case 1 and case 2 had two P waves and case 3 sinus rhythm.Ultrasonic cardiogram showed that in case 1 and case 2,the left and right atriums were enlarged and tricuspid valve had slight backstreaming,and in case 3,all of the cardiac chambers were normal and had no backstreaming of tricuspid valve and mitral valve.No abnormal findings were found in 3 cases by 4-9 times of coronary arteriongraphy.Conclusion The important factors for the patients' long-term survival after heart transplantation include the choice of appropriate donors and acceptors, protection of donors' hearts,selection of appropriate operations and suture methods,rational use of im- munosuppressants and prevention of cardiac allograft vasculopathy.