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Heart Transplantation in Infants and Children - Indications, Surgical Techniques and Special Considerations

  • C. B. Huddleston

Abstract

For some children with severe congenital malformations of the heart or end-stage myopathic processes, cardiac replacement offers the only hope of survival. The evolution of this treatment began in the late 1960s when Kantrowitz performed a heart transplant in a 16-day-old infant with tricuspid atresia[1]. Not long after that, Cooley performed a combination heart-lung transplant in a 2-month-old infant with an atrioventricular canal and pulmonary consolidation with pneumonia[2]. Neither of these infants survived their hospitalization, and in the 1970s fewer than 15 transplants in children were performed. The introduction of cyclosporin and the pioneering work of Bailey and associates at Loma Linda in neonatal transplantation were two significant developments of the 1990s which contributed to a steady increase in the volume of transplantation in children. According to the Registry for the International Society for Heart and Lung Transplantation[3] the number of children transplanted has plateaued since 1990 at 280–300 per year. Although heart transplantation (HTx) is a generally accepted therapy for children with medically refractory heart failure, controversies exist, such as the appropriateness of HTx for children with hypoplastic left heart syndrome. While it is true that HTx in children has been a direct extension from the experience gained in adults, there are substantial differences in practice from the standpoint of indications, surgical techniques, implications of immunosuppression on growth and response to infectious agents, and anticipated survival. This chapter will review the indications for HTx, the surgical techniques involved, the post-transplant management, and the results in children based on the published literature as well as the author’s personal experience.

Keywords

Pulmonary Artery Congenital Heart Disease Superior Vena Cava Hypoplastic Left Heart Syndrome Atrial Septum 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Kantrowitz A, Haller JD, Joos H, Cerruti MM, Carstensen HE. Transplantation of the heart in an infant and an adult. Am J Cardiol. 1968;22:782.PubMedCrossRefGoogle Scholar
  2. 2.
    Cooley DA, Bloodwell RD, Hallman GL et al. Organ transplantation for advanced cardiopulmonary disease. Ann Thorac Surg. 1969;8:30.PubMedCrossRefGoogle Scholar
  3. 3.
    Hosenpud JD, Novick RJ, Breen TJ, Keck B, Daily P. The Registry of the International Society for Heart and Lung Transplantation: twelfth official report-1995. J Heart Lung Transplant. 1995;14:805.PubMedGoogle Scholar
  4. 4.
    Penkoske PA, Rowe RD, Freedom RD et al. The future of heart and heart-lung transplantation in children. Heart Transplant. 1984;3:233.Google Scholar
  5. 5.
    Murphy JG, Gersh BJ, Mair DD et al. Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med. 1993;329:593.PubMedCrossRefGoogle Scholar
  6. 6.
    Turina M, Siebenmann R, Nussbaumer P, Senning A. Long-term outlook after atrial correction of transposition of great arteries. J Thorac Cardiovasc Surg. 1988;95:828.PubMedGoogle Scholar
  7. 7.
    Williams WG, Trusler GA., Kirklin JW et al. Early and late results of a protocol for simple transposition leading to an atrial switch (Mustard) repair. J Thorac Cardiovasc Surg. 1988;95:717.PubMedGoogle Scholar
  8. 8.
    Fontan F, Kirklin JW, Fernandez G et al. Outcome after a ‘perfect’ Fontan operation. Circulation. 1990;81:1520.PubMedGoogle Scholar
  9. 9.
    Cromme-Dijkhuis AH, Hess J, Hahlen K et al. Specific sequelae after Fontan operation at mid-and long-term follow-up. J Thorac Cardiovasc Surg. 1993;106:1126.PubMedGoogle Scholar
  10. 10.
    Menkis AH, McKenzie N, Novick RJ et al. Expanding applicability of transplantation after multiple prior palliative procedures. Ann Thorac Surg. 1991;52:722.PubMedCrossRefGoogle Scholar
  11. 11.
    Bailey LL, Nehlsen-Cannarella SL, Doroshow RW et al. Cardiac allotransplantation in newborns as therapy for hypoplastic left heart syndrome. N Engl J Med. 1986;315:949.PubMedCrossRefGoogle Scholar
  12. 12.
    Bailey LL, Gundry SR, Razzouk AJ et al. Bless the babies: one hundred lifteen late survivors of heart transplantation during the first year of life. J Thorac Cardiovasc Surg. 1993;105:805.PubMedGoogle Scholar
  13. 13.
    Pigott JD, Murphy JD, Barber G, Norwood WI. Palliative reconstructive surgery for hypoplastic left heart syndrome. Ann Thorac Surg. 1988;45:122.PubMedCrossRefGoogle Scholar
  14. 14.
    Sade RM, Crawford FA, Fyte DA. Symposium on hypoplastic left heart syndrome. J Thorac Cardiovasc Surg. 1986;91:937.PubMedGoogle Scholar
  15. 15.
    Iannettoni MD, Bove EL, Mosca RS et al. Improving results with first-stage palliation for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg. 1994;107:934PubMedGoogle Scholar
  16. 16.
    Norwood WI. Hypoplastic left heart syndrome. Ann Thorac Surg. 1991;52:688.PubMedCrossRefGoogle Scholar
  17. 17.
    Pennington DG, Noedel N, McBride LR, Naunheim KS, Ring WS. Heart transplantation in children: an international survey. Ann Thorac Surg. 1991;52:710.PubMedCrossRefGoogle Scholar
  18. 18.
    Griffin ML, Hernandez A, Martin TC et al. Dilated cardiomyopathy in infants and children. J Am Coll Cardiol. 1988;11:139.PubMedCrossRefGoogle Scholar
  19. 19.
    Smythe JF, Dyck JD, Smallhom JF, Freedom RM. Natural history of cardiac rhab-domyoma in infancy and childhood. Am J Cardiol. 1990;66:1247.PubMedCrossRefGoogle Scholar
  20. 20.
    Addonizio LJ, Gersony WM, Robbins RC et al. Elevated pulmonary vascular resistance and cardiac transplantation. Circulation. 1987;76(Suppl.V): V52.PubMedGoogle Scholar
  21. 21.
    Trento A, Griffith BP, Flicker FJ et al. Lessons learned in pediatric heart transplantation. Ann Thorac Surg. 1989;48:617.PubMedCrossRefGoogle Scholar
  22. 22.
    Murphy J. Buying time for a sick heart-preoperalive care of the newborn with hypoplastic left heart syndrome. J Heart Lung Transplant. 1991;10:804.Google Scholar
  23. 23.
    Pennington DG, Codd JE, Merjavy JP et al. The expanded use of ventricular bypass systems for severe cardiac failure and as a bridge to cardiac transplantation. J Heart Transplant. 1983;3:38.Google Scholar
  24. 24.
    Silka MJ, Kron J, Dunnigan A, Dick M. Sudden cardiac death and the use of implantable cardioverter-defibrillators in pediatric patients. Circulation. 1993;87:800.PubMedGoogle Scholar
  25. 25.
    Spray TL, Huddleston CB, Canter CE. Technique of transplantation for hypoplastic left heart syndrome with left superior vena cava. Ann Thorac Surg. 1993;55:779.PubMedCrossRefGoogle Scholar
  26. 26.
    Chiavarelli M, DeBegona JA, Vigesa RE et al. Heart transplantation in children. Adv Cardiac Surg. 1992;3:155.Google Scholar
  27. 27.
    Vouhe P. Technical aspects of heart transplantation in complex congenital heart defects. J Heart Lung Transplant. 1991;10:815Google Scholar
  28. 28.
    Doty DB, Renlund DG, Caputo GR, Burton NA, Jones KW. Cardiac transplantation in situs inversus. J Thorac Cardiovasc Surg. 1990;99:493.PubMedGoogle Scholar
  29. 29.
    Razzouk AJ, Gundry SR, Chinnock RE et al. Orthotopic transplantation for total anomalous pulmonary venous connection associated with complex congenital heart disease. J Heart Lung Transplant. 1995;14:713.PubMedGoogle Scholar
  30. 30.
    Nehlsen-Cannarella S. The unique newborn immune response. J Heart Lung Transplant. 1991;10:828.PubMedGoogle Scholar
  31. 31.
    Balzer DT, Moorhead S, Saffitz J, Huddleston CB, Spray TL, Canter CE. Utility of surveillance biopsies in infant heart transplant recipients. J Heart Lung Transplant. 1995;14:1095.PubMedGoogle Scholar
  32. 32.
    Shirali G, Cephus C, Dyar et al. Coarctation of aorta following infant/pediatric cardiac transplantation. J Heart Lung Transplant. 1996;15:S71.Google Scholar
  33. 33.
    Braunlein EA, Hunter DW, Canter CE et al. Coronary artery disease in pediatric cardiac transplant recipients receiving triple-drug immunosuppression. Circulation 1991;84(Suppl.III):III–303.Google Scholar
  34. 34.
    Huddleston CB, Mendeloff EN, Canter CE. Growth following heart transplantation in neonates. J Heart Lung Transplant. 1996;15:S82.Google Scholar
  35. 35.
    Baum MF, Chinnock RE, Larsen RL et al. Intermediate follow up of somatic growth of infant heart transplant recipients. J Heart Lung Transplant. 1996:15:S82.Google Scholar

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© Kluwer Academic Publishers 1996

Authors and Affiliations

  • C. B. Huddleston

There are no affiliations available

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