Transplantation of an oversized heart.
In response to the limited number of available donors, the criteria for accepting hearts have been expanded. In a 46-year-old female (160 cm, 56 kg) with a body surface area (BSA) of 1.58 m(2), an orthotopic heart transplantation was performed. She received the heart from a 34-year-old male donor (190 cm, 90 kg, BSA 2.58 m(2)). During transplantation, the obvious difference between the donor's heart and the recipient's pericardium did not cause a technical problem. However, the postoperative course was characterized by severe circulation problems. Due to a hemodynamically significant right heart impression, a consecutive pericardectomy had to be performed. After excision of the left and the right side of the pericardium, the patient returned to a stable condition. The consecutive course was without cardiopulmonary problems and the patient was discharged from the hospital 20 days later. The last twelve-month follow-up showed good cardiac function and excellent physical condition. We conclude that an oversized donor heart can be used for heart transplantation as long as the pericardium is left open and a left and right pericardectomy is performed.
Trummer
G
G
Department of Cardiovascular Surgery, Albert-Ludwigs-University Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany. georg_trummer@yahoo.com
Berchtold-Herz
M
M
Hillmann
R
R
Martin
J
J
Beyersdorf
F
F
D000328:Adult; D001775:Blood Circulation / Q000502:physiology; D001830:Body Surface Area; D006332:Cardiomegaly / Q000503:physiopathology / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010492:Pericardiectomy; D010496:Pericardium / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D014019:Tissue Donors