Pediatric cardiac transplantation for congenital heart defects: Surgical considerations and results

Vouhé, Pascal; Tamisier, Daniel; Bidois, J. Le; Sidi, Daniel; Mauriat, Philippe; Pouard, Philippe; Lefebvre, Didier; Albanese, Sonia B.; Khoury, Wassim; Kachaner, J; Leca, F

doi:10.1016/0003-4975(93)90660-a

Cited by 56 publications

(27 citation statements)

References 11 publications

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“…Partial groin bypass was utilized in 50% of the patients in order to maintain systemic perfusion during the period of instituting standard cardiopulmonary bypass. Similar to other studies (5,7,14,15,51), mean bypass and ischemic times were relatively long in this group of patients (4.8 Ϯ 1.4 h and 4.6 Ϯ 1.5 h), indicating the complexity of the surgical repair. Reconstructive surgery was required in 91% of patients, not only to restore normal systemic venous return, but also to correct multiple extracardiac lesions such as distorted pulmonary arteries (13,14,17,52).…”

Section: Patient Populationsupporting

confidence: 88%

“…The surgical approach to patients undergoing transplantation after a Glenn or Fontan procedure offers a unique challenge (2,4,7,10,12,14,50). Partial groin bypass was utilized in 50% of the patients in order to maintain systemic perfusion during the period of instituting standard cardiopulmonary bypass.…”

Section: Patient Populationmentioning

confidence: 99%

“…Although the results of palliative surgery for patients with single ventricle have improved markedly over the past 20 years (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), these patients remain at risk for late morbidity and mortality (16 -20). Survival rates after a "perfect" Fontan operation have been reported to be between 70% to 93% at five years and 60% to 81% at 10 years (2)(3)(4)(5)10).…”

mentioning

confidence: 99%

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Cardiac transplantation after the Fontan or Glenn procedure

Jayakumar

Addonizio

Kichuk-Chrisant

et al. 2004

Journal of the American College of Cardiology

208

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Section: Patient Populationsupporting

confidence: 88%

Section: Patient Populationmentioning

confidence: 99%

mentioning

confidence: 99%

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Cardiac transplantation after the Fontan or Glenn procedure

Jayakumar

Addonizio

Kichuk-Chrisant

et al. 2004

Journal of the American College of Cardiology

208

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show abstract

“…Third, the conventional technique of transplantation [40] may not be possible in the context of congenital heart disease because of the unusual anatomy, and the distortion of various structures by previous surgery. However, technical adjustments, including the cannulation techniques, have been described to deal with such possible distortions and malformations [26][27][28][29][30][31]. Therefore, no anatomic variation, nor any form of distortion caused by previous surgery, would preclude transplantation.…”

Section: The Operationmentioning

confidence: 99%

Transplantation for adults with congenital heart disease☆

Hosseinpour

Cullen

Tsang

2006

European Journal of Cardio-Thoracic Surgery

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Heart transplantation is a recognised treatment for end-stage heart failure of any cause including congenital heart disease. Congenital heart disease has contributed relatively little to the adult heart transplant activities in the past two decades. However, this is likely to change as an increasing number of children with congenital heart disease reach adulthood because of the advances in paediatric cardiology and surgery. Some of these grown-ups with congenital heart disease (GUCH patients) will need transplantation for late myocardial dysfunction either secondary to uncorrected lesions, or despite previous repair or palliative surgery. These patients are managed along the same clinical principles as those with cardiac failure of other aetiologies, despite the lack of any evidence to support this approach. Nevertheless, they introduce new challenges. First, some may have pulmonary vascular disease and require heart-lung transplantation, or lung transplantation combined with repair of their cardiac defects. Second, those with failing Fontan circulation are usually much sicker than other transplant candidates, with protein-losing enteropathy along with renal and hepatic dysfunction. Third, a suitable donor organ may not be found due to elevated levels of antibodies in response to previous blood transfusions and possibly the previous implantation of homografts. Fourth, the operation may be technically difficult because of the presence of adhesions secondary to previous operations, collaterals, and unusual anatomy. Fifth, postoperative care may be complicated because of predisposition to bleeding, infection and pulmonary hypertension, and the presence of residual aortopulmonary collaterals resulting in a significant left-to-right shunt. Despite a higher early mortality, the overall results of heart transplantation so far have been encouraging with survivals similar to that of adults with acquired heart disease and that of the paediatric population. However, this may change as the proportion of high-risk patients (failing Fontans) increases. GUCH patients with Eisenmenger's syndrome may be offered lung transplantation with repair of the cardiac defect or heart-lung transplantation. However, because of the limited success of these approaches, and improved management of pulmonary hypertension, patient selection remains difficult.

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“…In neonates and infants, the intrinsic neural pathways are considered to be important for radiofrequency ablation that is performable in cases of incessant supraventricular and atrioventricular nodal re-entry tachycardia (Osborn et al 1999;Blaufox et al 2001;Shah et al 2001;Oudijk et al 2003;Van Hare et al 2004). Injury of ICNS after neonatal heart transplantation may cause the development of coronary artery disease (Vouhe et al 1993;Larsen et al 1998;Vranicar et al 2000).…”

Section: Introductionmentioning

confidence: 99%

Location and variability of epicardiac ganglia in human fetuses

Saburkina

Pauža

2006

Anat Embryol

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The aim of the study was to determine the morphology of epicardiac ganglia in human fetuses at different stages of their development as these ganglia are considered to be of a pivotal clinical importance. Twenty-one fetal hearts were investigated applying a technique of histochemistry for acetylcholinesterase to visualize the epicardiac neural ganglionated plexus with its subsequent stereoscopic examination on total organs. In all of the examined fetuses, epicardiac neural plexus with numerous ganglia was well recognizable and could be clearly differentiated into seven ganglionated subplexuses, topography and structural organization of which were typical for hearts of adult human. The largest ganglion number comprising 77% of all counted ganglia was identified on the dorsal atrial surface. Fetal epicardiac plexus in gestation period of 15-40 weeks contained 929 +/- 62 ganglia, but ganglion amount did vary substantially from heart to heart. In conclusion, this study implies that the human fetal epicardiac ganglia occupy their definitive location already at gestation period from 15 weeks and their number as well as distribution on heart surface presumably is not age dependent.

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Pediatric cardiac transplantation for congenital heart defects: Surgical considerations and results

Cited by 56 publications

References 11 publications

Cardiac transplantation after the Fontan or Glenn procedure

Cardiac transplantation after the Fontan or Glenn procedure

Transplantation for adults with congenital heart disease☆

Location and variability of epicardiac ganglia in human fetuses

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