ABSTRACT
Thanks to progress in cardiac surgery and cardiology, pediatric patients with complex congenital heart conditions who would previously have died are now reaching adulthood. Patients with transposition of the great arteries who have undergone atrial repair can present during follow-up with progression towards heart failure as a result of progressive systemic right ventricular failure. In this situation, heart transplantation is a possible therapeutic option. Anatomic abnormalities and the presence of intraatrial conduits ensure that transplantation must involve a number of technical modifications. Here, we present our experience during 1992-2004 with heart transplantations in four patients with transposition of the great arteries and atrial repair. There was no operative mortality. During follow-up (mean period, 75 months), there was one death due to chronic rejection. The other patients remain in New York Heart Association class I, with normally functioning grafts.
Subject(s)
Heart Transplantation , Transposition of Great Vessels , Adolescent , Adult , Child , Coronary Angiography , Female , Graft Rejection/epidemiology , Humans , MaleABSTRACT
Debido a la evolución de la cirugía cardiaca y la cardiología, los pacientes pediátricos que antaño fallecían a causa de cardiopatías congénitas actualmente llegan a la edad adulta. Los pacientes con transposición de grandes vasos y reparación fisiológica en el seguimiento pueden evolucionar hacia la insuficiencia cardiaca, como consecuencia del fallo progresivo del ventrículo derecho en posición sistémica. En esta situación, el trasplante cardiaco aparece como una posible alternativa terapéutica. Las alteraciones anatómicas y la presencia de conductos intraauriculares hacen que el trasplante precise de una serie de variaciones técnicas. Presentamos la experiencia en nuestro centro. Entre 1992 y 2004 se han realizado cuatro trasplantes cardiacos en transposición de grandes vasos y corrección fisiológica. No hubo mortalidad quirúrgica. Durante el seguimiento (media, 75 meses), se produjo una muerte por rechazo crónico. Los demás pacientes presentan clase I de la NYHA, con injerto normofuncionante
Thanks to progress in cardiac surgery and cardiology, pediatric patients with complex congenital heart conditions who would previously have died are now reaching adulthood. Patients with transposition of the great arteries who have undergone atrial repair can present during follow-up with progression towards heart failure as a result of progressive systemic right ventricular failure. In this situation, heart transplantation is a possible therapeutic option. Anatomic abnormalities and the presence of intraatrial conduits ensure that transplantation must involve a number of technical modifications. Here, we present our experience during 1992-2004 with heart transplantations in four patients with transposition of the great arteries and atrial repair. There was no operative mortality. During follow-up (mean period, 75 months), there was one death due to chronic rejection. The other patients remain in New York Heart Association class I, with normally functioning grafts
