[Experience with heterotopic heart transplantation in patients with elevated pulmonary vascular resistance: late follow-up].
BACKGROUND
Along the past few years the number of papers on heterotopic cardiac transplant has been very scarce in the medical literature, including at the international level; this is particularly true in reference to the long term follow-up of these patients and the reason which led to the presentation of our report.


OBJECTIVE
To report the initial clinical experience and late evolution of 4 patients undergoing heterotopic heart transplantation, indications for this procedure and its major complications.


METHODS
The surgeries were performed between 1992 and 2001, and all had as indication for heterotopic transplantation the PVR, which ranged from 4.8 WU to 6.5 WU, with a transpulmonary gradient above 15 mmHg. In the 3rd patient, a direct anastomosis between the pulmonary arteries was performed without the use of a prostetic tube, and a mitral valvuloplasty and a LV aneurysmectomy were performed in the native heart. The immediate immunosuppressive regimens were double, with cyclosporine and azathioprine in the first 3 patients, and cyclosporine and mycophenolate mofetil in the 4th patient.


RESULTS
One immediate death occurred from graft failure, one death occurred after 2 (1/2) years, from endocarditis in an intraventricular thrombus in the native heart, and a third death occurred 6 years after transplantation, from post-operative complications of the aortic valve surgery in the native heart. The remaining patient is well, 15 years after the transplantation. This patient is in functional class II (NYHA), 6 years after a surgical occlusion of the native heart aortic valve.


CONCLUSIONS
Heterotopic heart transplantation results are inferior to those of orthotopic heart transplantation because they present higher RVP. The intraventricular thrombi, in the native heart, which require prolonged anticoagulation, and aortic valve complications, also in the native heart, may require surgical treatment. However, a patient's 15-year survival has demonstrated a long-term effectiveness of this option for selected patients.
Vila
Jose Henrique Andrade
JH
Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil. jhavila@cardiol.br
Silva
José Pedro da
JP
Fonseca
Luciana da
Ld
Baumgratz
José Francisco
JF
Tangari
Américo
A
Leite
Weverton Ferreira
WF
Guilhen
Claudia Jesus
CJ
Armelin
Egas
E
D000328:Adult; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000473:pathology; D008875:Middle Aged; D016042:Transplantation, Heterotopic / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D016896:Treatment Outcome