[Cardiac transplantation for old congenital heart diseases after multiple surgery].
Of the 100 consecutive patients undergoing cardiac transplantation between January 1988 and October 1993, 4 patients had terminal cardiac failure related to congenital heart disease after multiple prior palliative procedures (transposition of the great arteries, N = 1, tricuspid atresia, N = 1, single ventricle, N = 2). The prior palliative or curative operations (average 3.75 procedures per patient) modified essentially the systemic venous return and the pulmonary arteries. The technique of "subtotal" cardiac transplantation enabled anatomical reconstruction without prosthetic material in all cases by extensive usage of the donor tissue. There was no hospital mortality. There were no specific postoperative complications. The long-term results were comparable to those of the rest of the transplanted population. Patients with congenital heart disease in a terminal condition should be considered as candidates for cardiac transplantation. The difficulties related to anatomical abnormalities caused by prior surgery may be overcome and should not be considered a contra-indication to transplantation, providing pulmonary arterial resistances are taken into consideration.
Service de chirurgie cardiovasculaire et cardiaque pédiatrique, centre chirurgical Marie-Lannelongue et université Paris XI.
L
L
Macé
P
P
Dervanian
J
J
Petit
L
L
Houyel
J M
JM
Grinda
T A
TA
Folliguet
J P
JP
Duffet
R
R
Nottin
J Y
JY
Neveux
D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D011651:Pulmonary Artery / Q000503:physiopathology; D012086:Reoperation; D014655:Vascular Resistance
Transplantation cardiaque pour cardiopathies congénitales vieillies multi-opérées.