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Ann Thorac Surg 1995;59:813-820
© 1995 The Society of Thoracic Surgeons

Lung Transplantation in Children and Young Adults With Cardiovascular Disease

Nancy D. Bridges, MD, George B. Mallory, Jr, MD, Charles B. Huddleston, MD, Charles E. Canter, MD, Stuart C. Sweet, MD, Thomas L. Spray, MD

Divisions of Cardiothoracic Surgery, Pediatric Pulmonology, and Pediatric Cardiology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, Missouri

Single or bilateral lung transplantation was performed in 20 patients with pulmonary hypertension or an inadequate pulmonary vascular bed; all but 1 had congenital heart disease. The average age was 6.3 years (range, 3 months to 23.9 years). All were in New York Heart Association class IV, and 6 were hospitalized and receiving intensive support before transplantation. Hospital survival was 70% (14/20), with three additional deaths at 7, 11, and 27 months. A prior thoracic operation contributed to three of six hospital deaths from hemorrhage. All late deaths were due directly or indirectly to obliterative bronchiolitis. At a mean follow-up of 19 months (range, 2 to 48 months), 10 of 11 survivors are in New York Heart Association class I. Survival after hospital discharge and incidence of obliterative bronchiolitis are similar in a contemporary group of 41 patients of comparable age who underwent lung transplantation for pulmonary disease (p = not significant). Single or bilateral lung transplantation is an acceptable therapy for children with pulmonary hypertension, congenital heart disease, or both. Further investigation in the areas of pretransplantation survival, operative risk factors, and long-term outcome of single-lung recipients and recipients with hemodynamically insignificant intracardiac lesions are needed to develop optimal decision-making strategies for these patients.


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DISCUSSION
Ann. Thorac. Surg. 1995 59: 820-821. [Extract] [Full Text]



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