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Ann Thorac Surg 1991;52:112-117
© 1991 The Society of Thoracic Surgeons

Articles

Pediatric heart transplantation for congenital heart disease and cardiomyopathy

F.W. Hehrlein, MD*, H. Netz, MD, R. Moosdorf, MD, F. Dapper, MD, H.H. Scheld, MD, J. Bauer, MD, J. Boldt, MD

Departments of Cardiovascular Surgery, Pediatric Cardiology, and Anesthesiology and Operative Intensive Care, Justus-Liebig-University, Giessen, Germany

Accepted for publication March 21, 1991.

* Address reprint requests to Dr Hehrlein, Justus-Liebig-Universität, Klinikstr, 29, D-6300 Giessen, Germany.

Orthotopic heart transplantation has become an accepted therapy for adult patients with end-stage heart disease. In newborns and infants, this procedure is still controversial because of the unknown long-term results and the lack of donor organs. Since March 1988, we have performed orthotopic heart transplantation in 11 infants and children with hypoplastic left heart syndrome (n = 6), cardiomyopathy (n = 4), or congenital endocardial fibroelastosis (n = 1). The smallest infant was 3 days old and weighed 2,650 g. Four of 15 potential donors had to be refused for various medical reasons, and 4 were transferred to our hospital for organ retrieval. Seven hearts were procured remotely. We accepted weight mismatches up to 105% between donor and recipient. There were three perioperative deaths, two in patients 5 and 17 days old with hypoplastic left heart syndrome and 1 in a 2-year-old patient with a dilated cardiomyopathy. All 3 patients had drug-resistant right heart failure. A 2-year-old girl with a dilated cardiomyopathy died 2 months after transplantation owing to severe pulmonary embolism originating from the superior vena cava. The remaining 7 patients are alive and well between 1 month and 31 months after transplantation. Angiographic follow-up has not revealed signs of graft atherosclerosis at 2 years.




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